WorldWideScience

Sample records for Autopsy

  1. Brain Autopsy

    Science.gov (United States)

    ... the phone with NIH, the funeral home, and Indiana University,” she recalls. “We ended up having to delay ... a pathology program. There are many pathologists and medical centers that can confirm a diagnosis with autopsy including ...

  2. Needle autopsy

    Directory of Open Access Journals (Sweden)

    Philip Davis Marsden

    1997-04-01

    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.

  3. Touchless autopsy report

    OpenAIRE

    Rodrigues, César Augusto Cardoso

    2013-01-01

    This dissertation is a response to the most uncomfortable tasks in the medical examiners work, the tasks required to prepare an autopsy report. This is one of their biggest and most frequent limitations. The new technological tools of person-machine interface in the market motivated the realization of this project. This project is developed in Java, and allows a medical examiner to perform an autopsy report without requiring physical contact with the computer. Thus, this work has the followin...

  4. The value of neonatal autopsy.

    LENUS (Irish Health Repository)

    Hickey, Leah

    2012-01-01

    Neonatal autopsy rates were in decline internationally at the end of the last century. Our objective was to assess the current value of neonatal autopsy in providing additional information to families and healthcare professionals.

  5. Psychological Autopsies in Court.

    Science.gov (United States)

    Litman, Robert E.

    1984-01-01

    The crucial concept for defining suicide is intention. A major purpose of the psychological autopsy is to clarify the pre-mortem intentions of the victim, now deceased. This article reports cases in which the issue of suicide vs. accident came to trial because insurance benefits were at issue. (Author/BL)

  6. Autopsias pediátricas / Pediatric autopsies

    Scientific Electronic Library Online (English)

    Fernando, Fernández Reverón; José, Hurtado de Mendoza Amat; Teresita de Jesús, Montero González; Clara, Santamaría Cuadrado; Ana E, Mera Fernández.

    2014-12-01

    Full Text Available Introducción: la autopsia es una herramienta útil que garantiza el estudio más completo del enfermo y la enfermedad, y evalúa la calidad del trabajo médico. El estudio de las autopsias pediátricas ofrece un importante volumen de información. Objetivo: demostrar la utilidad de la autopsia para la eva [...] luación de la calidad de la atención médica pediátrica. Métodos: estudio retrospectivo longitudinal. Se estudiaron 363 autopsias pediátricas realizadas en el Hospital Militar Central "Dr. Luis Díaz Soto", desde su inauguración en 1962 hasta el 2011, a través del empleo del Sistema Automatizado de Registro y Control en Anatomía Patológica. Resultados: predominó el sexo masculino (56,1 %) y el grupo etario más frecuente correspondió al de 28 días a un 1 año (70,8 %). Las principales causas básicas de muerte fueron por infecciones digestivas, respiratorias y cerebrales. La principal causa directa e intermedia de muerte fue el tromboembolismo pulmonar. La discrepancia clínico patológica fue de un 14,7 % en la causa básica y de 10,3 % en la causa directa de muerte. Conclusiones: el trabajo científico combinado en 50 años de las especialidades de pediatría y anatomía patológica, demostró la utilidad de la autopsia para evaluar la calidad del trabajo médico y el apoyo que brinda el Sistema Automatizado de Registro y Control de Anatomía Patológica. Abstract in english Introduction: autopsy is a useful tool to guarantee the most complete study of the sick person and of the disease, and to evaluate the quality of the physician's work. The study of pediatric autopsies provides a huge volume of information. Objective: to prove the usefulness of autopsy for the evalua [...] tion of the quality of pediatric medical care. Methods: retrospective longitudinal study of 363 pediatric autopsies conducted at "Luis Diaz Soto" central military hospital since its opening in 1962 through 2011. To this end, the Automated System of Registration and Control in Pathological Anatomy was used. Results: predominance of males (56.1 %) and of the group aged 28 days to one year (70.8 %). The main causes of death were digestive, respiratory and brain infections. The main direct and intermediate cause of death was pulmonary thromboembolism. The clinical and pathological discrepancy was 14.7% in the main cause and 10.3 % in the direct cause of death. Conclusions: the combined scientific work in 50 years by the pediatrics and pathological anatomy specialties proved the usefulness of autopsy to evaluate the quality of the physician's work and the support given by the Automated System of Registration and Control of Pathological Anatomy.

  7. 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 particiogical technologists more actively participate in Ai. (K.T.)

  8. Napoleon's autopsy: new perspectives.

    Science.gov (United States)

    Lugli, A; Lugli, A Kopp; Horcic, M

    2005-04-01

    In 1821 Napoleon died in exile on the Island of St. Helena. Although the autopsy had suggested stomach cancer as the cause of death, in 1961 an elevated arsenic concentration was found in Napoleon's hair. This finding elicited numerous theories of conspiracy, treachery, and poisoning. Most recent reports even suggested inappropriate medical treatment may have contributed to the exiled Emperor's death. Napoleon's apparent obesity at the time of his demise was interpreted as a strong argument against stomach cancer as the cause of death; however, his weight changes over the course of his life, noticeable from the contemporary iconography, have not been systematically analyzed. To test the hypothesis that Napoleon's weight at death could be compatible with a diagnosis of terminal gastric cancer, we performed several studies to determine: a) Napoleon's weight at death; and b) the changes of his weight during the last 20 years of his life. Our weight modeling was based on the collection of 12 different pairs of trousers worn by Napoleon between 1800 and 1821, the year of his death. Modeling trouser sizes with control data suggested a weight increase from 67 kg to 90 kg by 1820. The trousers worn at the time of death suggested a subsequent weight loss of 11 kg (to 79 kg) during the last year of his life. This weight was confirmed by a second modeling approach based on the subcutaneous fat measurement performed at autopsy (1.5 inches) and a control group of 270 men dying from various causes. This provides a reasonable validation for both weight measurement methods. Napoleon's terminal weight loss of more than 10 kg is suggestive of a severe progressive chronic illness and is highly consistent with a diagnosis of gastric cancer. PMID:15891990

  9. 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

  10. The Autopsy of Squirrel Doe

    Science.gov (United States)

    Dick, Timothy T.; Watson, Jason

    2005-01-01

    Introductory biology laboratory experiences frequently rely on preserved chordates for anatomical study. Unfortunately, these preserved organisms rarely reflect the appearance of a living creature. Since community colleges are generally prohibited the use of live chordates, this paper describes the autopsy of a "road kill" squirrel to facilitate…

  11. Consent to autopsy for neonates

    OpenAIRE

    McHaffie, H.; Fowlie, P.; Hume, R.; Laing, I; Lloyd, D; Lyon, A

    2001-01-01

    OBJECTIVES—To determine parents' views on autopsy after treatment withdrawal.?DESIGN—Face to face interviews with 59 sets of bereaved parents (108 individual parents) for whose 62 babies there had been discussion of treatment withdrawal.?RESULTS—All except one couple were asked for permission for postmortem examination; 38% refused. The main reasons for declining were concerns about disfigurement, a wish to have the child left in peace, and a feeling that an aut...

  12. Medico-legal autopsies in Denmark

    DEFF Research Database (Denmark)

    Larsen, Sara Tangmose; Lynnerup, Niels

    2011-01-01

    At 2.7% in 1970, the Danish medico-legal autopsy frequency was lower than recent frequencies observed in the Nordic countries (4-24%). The aim of this study was to analyse trends in the number and frequency of Danish medico-legal autopsies.

  13. [Autopsy-a procedure of medical history?].

    Science.gov (United States)

    Petros, K; Wittekind, C

    2014-03-01

    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. PMID:23417503

  14. Autopsy and medical education: a review.

    OpenAIRE

    Charlton, R.

    1994-01-01

    During the twentieth century there has been a decline in the rate of autopsies performed. A review of the literature reveals reasons for this decline which include: an improvement in the medical diagnostic technology available; inadequate training of doctors as to the importance of autopsy; and difficulties in obtaining consent from relatives and the present use of audit. Recommendations for changes in medical education are made which include: a greater appreciation of the procedure as a usef...

  15. Plutonium in autopsy tissues in Great Britain

    International Nuclear Information System (INIS)

    A summary of the results are presented for plutonium concentrations in autopsy bone, liver and lung tissues obtained from people who had died in Scotland, north-eastern England, Oxfordshire and western Cumbria. Attempts were made to ensure that the subjects had not been occupationally exposed to plutonium in order that these results could be compared with autopsy tissue plutonium concentrations of Sellafield workers. Three cases from west Cumbria showing high tissue concentrations of plutonium were discovered to be former employees of Sellafield Works. (UK)

  16. Autopsy study of fatal deliberate self harm.

    Science.gov (United States)

    Arun, M; Palimar, Vikram; Menezes, Ritesh G; Babu, Y P Raghavendra; Bhagavath, Prashantha; Mohanty, Manoj Kumar

    2007-01-01

    A retrospective autopsy study of fatal deliberate self harm (FDSH) was undertaken in the mortuary of Kasturba Hospital, Manipal, Southern India over a period of 12 years (1993-2004). Out of 1917 cases autopsied, 21.2% were deaths due to deliberate self harm (DSH). The male sex (66.1%) and victims in the third decade of life (35.9%) predominated. More than two-thirds of the decedents were married. More fatalities were observed during the winter season (35.8%) and in the day time (62.2%). Dispair with life (61.9%) was the most common motive for FDSH. The majority of fatalities were due to poisoning (73.5%), where organophosphorous compounds topped the list (71.9%). About one-third of the victims survived for 18 to 24 hours after DSH. PMID:17345894

  17. Plutonium in autopsy tissues in Great Britain

    International Nuclear Information System (INIS)

    From time to time the authors have measured the Pu content of tissues taken at autopsy from people who had worked in the Pu-processing industries including some from Sellafield Works in Cumbria. During the work it became apparent that the results would be more enlightening if they could be compared with the levels of Pu in people who had not worked in the nuclear energy industries. With the objective of making this comparison, the authors commenced a series of Pu analyses on tissues removed at autopsy from members of the general public, who might be expected to have received their body deposits of Pu from fallout from atmospheric nuclear weapons explosions. This note augments some results reported previously in summary form

  18. Can postmortem fetal MR imaging replace autopsy?

    International Nuclear Information System (INIS)

    The purposes of this study were to compare postmortem fetal MRI findings with autopsy findings and to assess whether postmortem MRI can replace autopsy. The study group consisted of 13 stillborn fetuses, seven that died immediately after birth, and five terminated because of anomalies seen on prenatal sonograms. A total 17 were male, and eight were female, and their gestational ages were from 20 to 41 (average;28.2) weeks. Spin-echo T1-and T2-weighted axial, sagittal, and coronal MR images were obtained, and autopsy findings were divided into major and minor. A major finding was defined as an anomaly or syndrome which caused fetal death or termination of the pregnancy: minor findings were classified, on the basis of gross inspection, as internal or external. MR images were retrospectively analyzed by two radiologists unaware of the autopsy findings, and by comparison with these, the postmortem MRI detection rates for major and minor findings was then determined. In seven of 25 fetuses, MR imaging revealed major findings, a dietction rate of 100%. There were two cases of anencephaly, two of trisomy-18, and one each of hydrops fetalis with large cystic hygroma, diaphragmatic hernia, and Dandy-Walker malformation. Twenty-three of 60 minor findings (38.3%) were detected by MRI. The detection rates for external and internal findings were 29.6%(8/27) and 45.5%(15/33), respectively. Although a limitation of our study is the low detection rate for minor findings, postmortem ftion rate for minor findings, postmortem fetal MRI may help diagnose the major cause of fetal death

  19. The working procedure of human autopsy specimens

    International Nuclear Information System (INIS)

    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

  20. THE RELEVANCE OF CLINICAL AUTOPSIES IN A PSYCHIATRIC INSTITUTE

    OpenAIRE

    Chandra, Prabha S; Shankar, S. K.; Asha, T.; VYTHILINGAM, MEENA; Rao, T. Vasudev; Das, Sarala; Channabasavanna, S. M.

    1988-01-01

    The pattern of psychiatric syndromes/mental illnesses among the 61 clinical autopsies carried out during the past decade in a psychiatric Institute in South India, is documented. Among the cases autopsied, 26.2% had clinical diagnosis of Schizophrenia, 21.3% dementia, 19.67% manic depressive Psychosis, the rest being cases of neurosis, mental retardation, alcoholism and other Psychosis. The importance of an autopsy study in understanding the pathomorphological basis of mental illness is highl...

  1. Radiographic investigations during medico-legal autopsies

    International Nuclear Information System (INIS)

    During the last 13 years (1968-1980), 427 radiographic examinations were carried out during the course of medico-legal autopsies at the Institute of Forensic Medicine at the Free University of Berlin. Important problems were the demonstration of retained foreign bodies resulting from shooting, stabbing or blunt trauma, bone injuries, identification, and the question of life in neonates. An historical survey is given and 12 cases with special forensic problems are illustrated and discussed, and further means of investigations are described. (orig.)

  2. Verbal autopsy: current practices and challenges

    OpenAIRE

    Soleman Nadia; Chandramohan Daniel; Shibuya Kenji

    2006-01-01

    Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review o...

  3. Left Paraduodenal Hernia: An Autopsy Case

    DEFF Research Database (Denmark)

    Omland, Silje Haukali; Hougen, Hans Petter

    2011-01-01

    We present a case of a left paraduodenal hernia diagnosed at autopsy. A left paraduodenal hernia is an internal hernia of congenital origin due to the abnormal rotation of the midgut during embryonic development. Internal hernias are a rare cause of intestinal obstruction, with the paraduodenal being the most frequent. The clinical course can be asymptomatic, cause chronic or intermittent abdominal pain, or present with acute abdomen. The clinical entity is a diagnostic challenge, which is illustrated in the present case where there patient died during hospital admission. The case also emphasizes the difficulty in diagnosing the disease by plain abdominal radiography.

  4. Verbal autopsy: current practices and challenges.

    Science.gov (United States)

    Soleman, Nadia; Chandramohan, Daniel; Shibuya, Kenji

    2006-03-01

    Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process. PMID:16583084

  5. Verbal autopsy: current practices and challenges

    Directory of Open Access Journals (Sweden)

    Soleman Nadia

    2006-01-01

    Full Text Available Cause-of-death data derived from verbal autopsy (VA are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process.

  6. Value of postmortem computed tomography in comparison to autopsy

    International Nuclear Information System (INIS)

    Purpose: to assess the diagnostic value of postmortem computed tomography (CT) in comparison to autopsy. Materials and methods: twenty-seven cadavers were examined by sequential cranial CT and helical CT through the neck, thorax and abdomen and subsequently underwent an autopsy with histomorphologic examination of the pathologic specimens. The findings of CT, autopsy and histology were registered and compared by three radiologists and one specialist for forensic medicine, using a data entry form. Results: in 19 of 27 cases, the findings explaining the cause of death were concordant for CT and autopsy. Intracranial, intraspinal and intracardiac gas accumulations (n = 12) were registered by CT alone. The detection of skull fractures was equal for both methods (n = 3). CT showed diagnostic problems in the assessment of pneumonic infiltrations (n = 16) and pulmonary edema (n = 21). Conclusion: CT is a useful and complementary method to autopsy. (orig.)

  7. La Crisis de la Autopsia / The Autopsy in Crisis

    Scientific Electronic Library Online (English)

    Antonio, Martínez-Hernández.

    2000-05-01

    Full Text Available [...] Abstract in english In the Western world the autopsy rate is declining at an alarming rate. In the United States of America the rate in some academic hospitals is less than 7% of all hospital deaths. This decline has been documented and deplored in many countries, articles and books. Suggestions on how to resuscitate t [...] he autopsy range from mandatory in all hospital deaths to economic bonuses to the doctors obtaining the highest autopsy rate. All in vain, the autopsy decline continues. Pathologists deploring this decline blamed clinical colleagues, new social attitudes, the litigious nature of modern society, but few have questioned a procedure little changed in more than a century. Perhaps the time has come to abandon the "classic" autopsy and rethink the procedure so as to make it useful, alluring and indispensable for the contemporary, concerned clinician. (Rev Med Chile 2000; 128: 457-59)

  8. Diffuse Lewy Body Disease : An Autopsy Case

    Directory of Open Access Journals (Sweden)

    Kuroda,Shigetoshi

    1987-02-01

    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.

  9. Myocardial bridges: A prospective forensic autopsy study

    Directory of Open Access Journals (Sweden)

    Mici?-Labudovi? Jelena

    2015-01-01

    Full Text Available Introduction. When the coronary artery, located subepicardially, submerges into the myocardium and appears again subepicardially after a short intramural course, it represents an embedded coronary artery, while the part of the myocardium above is a myocardial bridge. Objective. We investigated the frequency of the embedded left coronary artery (LAD in the autopsy material considering the descending branch of the LAD to be the most important one in the nourishment of the myocardium and myocardial bridges to be the most frequent in its area, as well as clinically important. Methods. A prospective autopsy study of 975 cases was performed, including both, natural (21.33% and violent (78.67% deaths. The sample consisted of 74.56% males and 25.44% females. In order to discover myocardyal bridges and their characteristics, the hearts were examined by both transverse cuts and longitudinal openings of the LAD. Results. Myocardial bridge was found in 78 cases (8.00%, more commonly in males (9.35% than females (4.03%. The average length of the myocardial bridge was 21.85±16.10mm and thickness 3.744±1.48 mm. The common localization of the myocardial bridge was the proximal half of the LAD (89.74%. The upper part of the artery, proximal to the bridge, was a common site of atherosclerotic changes. Myocardial bridge was found in 12.50% of natural deaths, but in 13.38% out of all cases of sudden cardiac deaths. Conclusion. Therefore, the presence of the myocardial bridge by itself is not predominant, but it is certainly a contributing factor to a sudden cardiac death. [Projekat Ministarstva nauke Republike Srbije, br. 175093

  10. Autopsy in Islam and current practice in Arab Muslim countries.

    Science.gov (United States)

    Mohammed, Madadin; Kharoshah, Magdy A

    2014-03-01

    Autopsy, or post-mortem examination, is the dissection of a dead body. It is performed for many reasons. Attitudes toward dead bodies vary with religious beliefs and cultural and geographical backgrounds. We have carried out an extensive literature review to determine the Islamic view and current practice of Autopsy, in at least four Arab countries which published their experiences. Several research articles have studied the history of Islamic Autopsy as well as the current situation and legal debates about it. The overwhelming conclusion is that data is lacking. More must be published from Arabic Muslim countries and more research done to correct misconceptions. We also recommend more application of non-invasive Autopsy. PMID:24661712

  11. An autopsy study of maternal mortality: A tertiary healthcare perspective

    Directory of Open Access Journals (Sweden)

    Panchabhai T

    2009-01-01

    Full Text Available Background: An audit of autopsies of maternal deaths is important for the establishment of accurate cause of maternal deaths and to determine the contribution of various etiologies responsible in a given community. Aim: To study the causes of maternal deaths as determined by a pathological autopsy. Settings and Design: A retrospective study of all the cases of maternal deaths that underwent a pathological autopsy in a tertiary healthcare center from January 1998 to December 2006. Materials and Methods: The autopsy records with clinical notes were retrieved; gross and histopathology specimens and slides were studied to establish the accurate cause of maternal deaths. The variables like age (years, stay in the hospital, gravidity, trimester of pregnancy and method of delivery were used to classify and analyze the data from the autopsies. The causes of maternal deaths were divided in to direct and indirect; each being classified into subgroups based on the most evident pathology on autopsy. Results: The Maternal Mortality Rate (MMR over a nine-year period (1998-2006 was 827/100000 live births (471 maternal deaths against 56944 live births. An autopsy was performed in 277 cases (58.8%. In the autopsy group, the most common causes of maternal mortality were pre-ecclampsia/ecclampsia (40 of 277, 14.44% and hemorrhage (32 of 277; 11.55%; However, indirect causes like infectious diseases (27 of 277; 9.75% and cardiac (27 of 277; 9.75% disease also contributed to maternal deaths. Conclusion: Indirect causes like rheumatic heart disease and infections like tuberculosis, malaria or leptospirosis and nutritional anemia are still major causes of maternal mortality in developing countries like India. Intensive efforts need to be taken in these areas to reduce the maternal mortality in developing countries like India.

  12. Invasive pulmonary aspergillosis: A study of 39 cases at autopsy

    OpenAIRE

    Vaideeswar P; Prasad S; Deshpande J; Pandit S

    2004-01-01

    Background: Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals. Aims: To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations. Settings and Design: Retrospective analysis of autopsy material from a tertiary care hospital. Material and Methods: All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were an...

  13. Two forensic autopsy cases of death due to upper gastrointestinal hemorrhage: A comparison of postmortem computed tomography and autopsy findings.

    Science.gov (United States)

    Suzuki, Hideto; Hasegawa, Iwao; Hoshino, Norio; Fukunaga, Tatsushige

    2015-05-01

    In this report, we describe two autopsy cases of death due to upper gastrointestinal hemorrhage (Case 1: gastric ulcer, Case 2: aortoduodenal fistula). Postmortem computed tomography (CT) images from both cases revealed pooling of gastric fluid, which contained high attenuation areas, although these images also mirrored the different sources of the gastrointestinal hemorrhage. Fluid collection was observed in the small intestine for both cases, although the high attenuation areas were only remarkable in Case 2. The autopsy in Case 1 revealed a peptic ulcer, with small vessels exposed on the surface of the ulcer. Melena was also observed throughout the intestine, although clotting was only observed inside the stomach. The autopsy in Case 2 revealed diffuse massive clotting from the stomach to the upper portion of the ileum, which was due to a primary aortoduodenal fistula. Given our autopsy findings, the extent of the high attenuation areas in the digestive tract during postmortem CT scanning may be correlated with the speed of the gastrointestinal hemorrhage before death. Carefully evaluating the radiodensity of the gastrointestinal contents during postmortem CT scanning may indicate the primary site of the hemorrhage before the autopsy, thereby facilitating the accurate identification of the cause of death during forensic autopsy. PMID:25600888

  14. [Role of forensic autopsy in deaths caused by medical practice].

    Science.gov (United States)

    Funayama, Masato

    2013-03-01

    Autopsies are required to determine the cause of deaths due to medical practice. In Japan, some deaths resulting from medical practice are treated as criminal cases. In such instances, medicolegal autopsies ordered by the police or public prosecutors are performed. One problem with a medicolegal autopsy, however, is that judicial institutes often refuse to disclose coroners' reports. As a result, parties with an interest in the findings (the bereaved or medical institutions) are unable to receive detailed autopsy information for a long period of time. When an autopsy is performed by a medical examiner who is a government official, the rules governing the disclosure of the coroner's report may not be as strict, at least for the bereaved, although such a system is in place in only four regions of Japan. In April 2013, a new law pertaining to the cause of death will come into effect. However, it does not include new articles relating to deaths caused by medical practice, meaning that such deaths will continue to be investigated under existing regulations in the present law, which includes the Medical Practitioners' Act. The government plans to draft another law covering deaths related to medical practice, and it is hoped that clinical medical societies, including the Japan Surgical Society, will appeal to the government to solve problems related to the determination of the cause of deaths related to medical practice. PMID:23617191

  15. Neuropathologic findings after organ transplantation. An autopsy study.

    Science.gov (United States)

    Schwechheimer, K; Hashemian, A

    1995-05-01

    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

  16. Clinical diagnosis versus autopsy findings in polytrauma fatalities

    Directory of Open Access Journals (Sweden)

    Fakler Johannes K

    2010-10-01

    Full Text Available Abstract Objectives The aim of the study was to determine if differences in clinical diagnosis versus autopsy findings concerning the cause of death in polytrauma fatalities would be detected in 19 cases of fatal polytrauma from a Level 1 trauma centre. Methods Clinical diagnoses determining the cause of death in 19 cases of fatal polytrauma (2007 - 2008 from a Level 1 trauma centre were correlated with autopsy findings. Results In 13 cases (68%, the clinical cause of death and the cause of death as determined by autopsy were congruent. Marginal differences occurred in three (16% patients while obvious differences in interpreting the cause of death were found in another three (16% cases. Five fatalities (three with obvious differences and two with marginal differences were remarked as early death (1-4 h after trauma and one fatality with marginal differences as late death (>1 week after trauma. Obvious and marginal discrepancies mostly occurred in the early phase of treatment, especially when severely injured patients were admitted to the emergency room undergoing continued cardiopulmonary resuscitation, i. e. limiting diagnostic procedures, and thus the clinical cause of death was essentially determined by basic emergency diagnostics. Conclusions Autopsy as golden standard to define the cause of death in fatal polytrauma varies from the clinical point of view, depending on the patient's pre-existing condition, mechanism of polytrauma, necessity of traumatic cardiopulmonary resuscitation, survival time, and thus the possibility to perform emergency diagnostics. An autopsy should be performed at least in cases of early fatal polytrauma to help establishing the definite cause of death. Moreover, autopsy data should be included in trauma registries as a quality assessment tool.

  17. A safer method for body restoration following autopsy.

    Science.gov (United States)

    Duflou, Johan; McNamara, Bradley; Cluney, Robert

    2014-01-01

    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. PMID:24117624

  18. Invasive pulmonary aspergillosis: A study of 39 cases at autopsy

    Directory of Open Access Journals (Sweden)

    Vaideeswar P

    2004-01-01

    Full Text Available Background: Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals. Aims: To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations. Settings and Design: Retrospective analysis of autopsy material from a tertiary care hospital. Material and Methods: All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were analysed with respect to their clinical presentation, predisposing factors, gross and histological features, complications and causes of death. Results: Among a total of 20475 autopsies performed in 12 years, 39 patients (0.19 % had invasive pulmonary aspergillosis. There were 28 males and 11 females. Their ages ranged from five months to 67 years. Dyspnoea, fever, cough with mucopurulent expectoration, chest pain and haemoptysis were commonly encountered symptoms. Forty-one per cent of the patients had no respiratory symptoms. Fungal aetiology was not entertained clinically in any of the patients. The major underlying conditions were prolonged antibiotic therapy, steroid therapy, and renal transplantation, often associated with underlying lung diseases. Pneumonia, abscesses, vascular thrombosis and infarction were common findings at autopsy. Antecedent tuberculosis, mucormycosis, Pneumocystis carinii pneumonia and Cytomegalovirus infection were also present. In most cases, death was related to extensive pulmonary involvement or fungal dissemination. Conclusion: A diagnosis of invasive pulmonary aspergillosis should always be borne in mind whenever one is dealing with recalcitrant lung infections even with subtle immunosuppression. Radiological investigations and serologic markers can be utilised for confirmation and prompt therapy.

  19. 28 CFR 549.80 - Authority to conduct autopsies.

    Science.gov (United States)

    2010-07-01

    ...permission of the family or next-of-kin, the following message is to be included in the telegram notifying the family or next-of-kin...performed within 48 hours. While a decision on an autopsy is pending, no action should be taken that will affect the...

  20. Renal arterial aneurysm--an incidental finding at autopsy.

    Directory of Open Access Journals (Sweden)

    Vaideeswar P

    1998-01-01

    Full Text Available Herein we describe a rare case of saccular renal artery aneurysm seen as an incidental autopsy finding in an elderly, hypertensive female. The aneurysm was seen as a small exophytic mass with calcified wall and lumen occluded by recanalized thrombus.

  1. Mittelmeier hip prosthesis autopsy study 2 years after implantation.

    OpenAIRE

    Brach Del Prever, Elena Maria

    1983-01-01

    A Mittelmeier hip prosthesis was removed at autopsy 2 years after implantation in a patient who was fatally injured. Macroscopic, histological, radiographic, and metrological studies revealed interesting new aspects on the remodelling of bone and the behaviour of the components of the prosthesis.

  2. Psychological Autopsy Provides Insight into Gifted Adolescent Suicide.

    Science.gov (United States)

    Cross, Tracy

    1996-01-01

    This article highlights findings of a study on the suicides of three academically talented male adolescents. Results of the psychological autopsies are reported in terms of commonalities with adolescent suicide in the general population; commonalities among the three cases related to their giftedness; and themes emerging across the cases,…

  3. The American Theological Seminary: An Unfamiliar Institutional Autopsy

    Science.gov (United States)

    Lumadue, Richard

    2010-01-01

    Christian educators can learn much from institutional autopsies of Christian schools of higher education that have failed. The untold story of the now-defunct American Theological Seminary (ATS) in St. Augustine, Florida, provides an excellent example of critical errors that Christian educators can learn from to avoid the same fate. An…

  4. Cerebral infarction in autopsies of chagasic patients with heart failure

    OpenAIRE

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

    2003-01-01

    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 anatom...

  5. Foetal Autopsy-Categories and Causes of Death

    OpenAIRE

    Fatima, Uroos; Sherwani, Rana; Khan, Tamkin; Zaheer, Sufian

    2014-01-01

    Introduction: Intrauterine death(IUD)/ Stillbirth forms a major part of perinatal mortality which thereby is a good indicator of pregnancy wastage as well as quality of healthcare available. The key objectives of autopsy examination are to know the cause(s) of death, elucidation of pathogenic mechanism and quality control of clinical management. The aim of this study was to identify the prevalent causes of IUD, thereby taking appropriate measures to prevent them and decrease the perinatal mor...

  6. Acute fulminant myocarditis at autopsy: A clinical masquerade?

    OpenAIRE

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

    2012-01-01

    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 p...

  7. Imaging and virtual autopsy: looking back and forward.

    Science.gov (United States)

    Bolliger, Stephan A; Thali, Michael J

    2015-08-01

    In order to create a three-dimensional (3D) documentation of findings which can be reassessed if necessary by other experts, the research project 'Virtopsy®' was launched in the late 1990s. This project combined autopsy results with forensic imaging in the form of computed tomography, magnetic resonance tomography and 3D surface scanning. The success of this project eventually succeeded in convincing the courts in Switzerland to accept these novel methods as evidence. As opposition towards autopsies has grown over the last decades, Virtopsy also strives to find and elaborate additional methods which can answer the main forensic questions without autopsy. These methods comprise post-mortem angiography for illustration of the vascular bed and image-guided tissue and fluid sampling for histological, toxicological and microbiological examinations. Based on the promising results, post-mortem imaging, especially with 3D surface scanning, has meanwhile also been applied to living victims of assault, who have suffered patterned injuries due to bites, blows with objects, etc. In our opinion, forensic imaging is an objective method which offers the possibility for a reassessment of the findings by other experts, even after burial or cremation of the corpse, or healing of the injuries in living victims, thus leading to a greater security in court. PMID:26101279

  8. An exploratory study of the pattern of consent for autopsy in a regional hospital setting.

    LENUS (Irish Health Repository)

    Kaar, T K

    2012-02-03

    A prospective study of the pattern of responses to requests for autopsy in a general surgical unit was performed. Information on the characteristics of the deceased, of the requestee and of the requester was documented in the case of 66 patients who died while in hospital. Permission to perform autopsy was not requested in 39 out of 66 cases and this was the most frequent contributory factor to the low rate of autopsy. Once a decision to grant or refuse autopsy is made by relatives of the deceased, the decision is unlikely to be reversed. Permission to perform autopsy was more likely to be sought when the deceased was male than when deceased was female. The relatives of patients who had recently undergone surgery were more likely to refuse permission for autopsy than were those of patients who had not had recent surgery.

  9. Coronary atherosclerosis in noncardiac deaths: An autopsy study

    Science.gov (United States)

    Vyas, Priti; Gonsai, Ratigar Narangar; Meenakshi, Charu; Nanavati, Meeta G.

    2015-01-01

    Introduction: Atherosclerosis leading to ischemic heart disease (IHD) is the most common cause of cardiac deaths worldwide. To evaluate the prevalence of atherosclerosis, an autopsy-based study conducted on subjects who died of noncardiac causes can be a valuable tool. With this hypothesis, we conducted this study on the hearts of subjects who died of noncardiac causes. Materials and Methods: This study was conducted from August 2012 to February 2013 at Department of Pathology, BJ Medical College, Ahmedabad, Gujarat. The deceased patients who died of noncardiac causes and underwent autopsy at our hospital, their hearts were sent to our department for histopathological analysis. The hearts were fixed in 10% formalin, weighed, measured, and the three main coronary arteries were dissected out and carefully examined for any histological evidence of atherosclerotic plaques and associated pathological lesions and graded according to the classification given by American Heart Association. Results: A total of 250 autopsy cases were evaluated. Amongst them 113 were deaths due to noncardiac causes, of which 83 (73.45%) subjects had evidence of atherosclerosis. In the study, 68 (82%) were males and 15 (18%) were females. Left anterior descending artery (LADA; 69%) was the most commonly involved coronary artery. Triple vessel disease was found in 22% of subjects. Conclusion: The study showed alarmingly high prevalence of atherosclerosis. The pathogenesis of coronary atherosclerosis begins at a younger age in Indian population. Though the incidence of atherosclerosis is more common in males compared to females; coronary atherosclerosis is an important risk factor for IHDs in both sexes and screening for the same should begin at an early age. PMID:25861201

  10. Voxel-based morphometry in autopsy proven PSP and CBD

    OpenAIRE

    Josephs, Keith A; Whitwell, Jennifer L.; Dickson, Dennis W.; Boeve, Bradley F.; Knopman, David S.; Petersen, Ronald. C.; Parisi, Joseph E.; Jack, Clifford R.

    2006-01-01

    The aim of this study was to compare the patterns of grey and white matter atrophy on MRI in autopsy confirmed PSP and CBD, and to determine whether the patterns vary depending on the clinical syndrome. Voxel-based morphometry was used to compare patterns of atrophy in 13 PSP and 11 CBD subjects and 24 controls. PSP and CBD subjects were also subdivided into those with a dominant dementia or extrapyramidal syndrome. PSP subjects showed brainstem atrophy with involvement of the cortex and unde...

  11. An autopsy case of pulmonary fissure induced by zygomycosis.

    Science.gov (United States)

    Imai, Yuichiro; Adachi, Yasushi; Kimura, Takashi; Nakano, Chikara; Shimizu, Toshiki; Shi, Ming; Okigaki, Mitsuhiko; Shimo, Tomohiko; Kaneko, Kazunari; Ikehara, Susumu

    2013-01-01

    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. PMID:23874118

  12. Hypothermia secondary to glioblastoma multiforme? Autopsy findings in two cases.

    Science.gov (United States)

    Morgan, Matthew; Schwartz, Liliana; Duflou, Johan

    2015-03-01

    Death due to accidental primary hypothermia in cold climates is relatively common, with previous case series reflecting this. In contrast, hypothermia-related death as a result of an underlying medical cause, such as a brain tumor, is rare. The literature clearly illustrates a theoretical causal relationship between brain neoplasms and hypothermia through the infiltration of the hypothalamus; however, the number of reported cases is minimal. Two cases are presented where autopsy confirmed hypothermia as the cause of death with both cases revealing widespread glioblastoma multiforme in the brain. Both decedents were elderly with a number of comorbidities identified during autopsy that could explain death; however, hypothermia was deemed the most likely cause. It is proposed that both decedents died of hypothermia as a result of the tumor's effect on thermoregulation. These cases underline the importance of forensic pathologists to be aware of the relationship between brain tumors and hypothermia and to not dismiss death as being due to other disease processes. PMID:25644717

  13. Autopsy practice in forensic pathology - Evidence-based or experience-based? : A review of autopsies performed on victims of traumatic asphyxia in a mass disaster

    DEFF Research Database (Denmark)

    Colville-Ebeling, Bonnie; Freeman, Michael

    2014-01-01

    Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case series, we describe the variation observed in autopsy reports by five different pathologists of eight victims who died simultaneously from traumatic asphyxia due to compression during a human stampede. We observed that there was no mention of the availability of medical charts in five of the reports, of potentially confounding resuscitation efforts in three reports, of cardinal signs in seven reports and of associated injuries to a various degree in all reports. Further, there was mention of supplemental histological examination in two reports and of pre-autopsy radiograph in six reports. We inferred that reliance on experience and individual customary practices led to disparities between the autopsy reports as well as omissions of important information such as cardinal signs, and conclude that such reliance increases the potential for error in autopsy practice. We suggest that pre-autopsy data-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy of the report as a legal document as well as rendering it more useful for data-gathering efforts.

  14. Correlation between prenatal diagnosis by ultrasound and fetal autopsy findings in second-trimester abortions

    DEFF Research Database (Denmark)

    Hauerberg, Laura; Skibsted, Lillian

    2012-01-01

    We evaluated the correlation between prenatal diagnosis by ultrasound and autopsy findings, based on 52 second-trimester pregnancies terminated due to fetal malformations or chromosome aberrations diagnosed at a gestational age of 12-25 weeks. In 24 pregnancies, there was full agreement between ultrasound and autopsy. In 23 fetuses, the main diagnosis was confirmed and additional or more specific findings were observed on autopsy. In five fetuses, there were considerable differences. Discrepancies between ultrasound and autopsy findings were mainly anomalies undetectable by ultrasound and thus expected; however, about one-third of the discrepancies were not expected, representing findings that were 'missed' at ultrasound. The main ultrasound diagnoses were confirmed in the majority of the pregnancies, but the additional information obtained at autopsy in more than half of the fetuses clearly shows the value and benefit of postmortem fetal examination following termination of a pregnancy.

  15. Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case

    Scientific Electronic Library Online (English)

    Talita, Zerbini; Luiz Fernando Ferraz da, Silva; Antonio Carlos Gonçalves, Ferro; Fernando Uliana, Kay; Edson, Amaro Junior; Carlos Augusto Gonçalves, Pasqualucci; Paulo Hilario do Nascimento, Saldiva.

    2014-12-01

    Full Text Available Objective: The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. Method: Comparison between the findings of different methods: autopsy an [...] d postmortem computed tomography. Results: In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. Conclusions: Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations.

  16. Correlated study of cerebral infarcts by CAT and autopsy

    International Nuclear Information System (INIS)

    The author aims to demonstrate the increased information which can be acquired from a correlated study of the computed tomogram and the pathomorphological patterns of the most common infarctions seen at autopsy. The discussion is divided into two sections: 1. A short bird's-eye view on the laws of distribution of flow in cases of cerebrovascular insufficiency, particularly all the deviations from simple hemodynamics in the process of infarction. 2. A systematic demonstration of the most frequent CT-patterns correlated with the corresponding pathomorphological specimens. This report is based on 6500 cerebral CTs, from which 590, i.e. 9%, showed infarcts. These include mainly cases seen in the neurological ward of the Merheim City Hospital. (Auth.)

  17. An autopsy case of vagus nerve stimulation following acupuncture.

    Science.gov (United States)

    Watanabe, Mayumi; Unuma, Kana; Fujii, Yusuke; Noritake, Kanako; Uemura, Koichi

    2015-03-01

    Acupuncture is one of the most popular oriental medical techniques in China, Korea and Japan. This technique is also popular as alternative therapy in the Western World. Serious adverse events are rare following acupuncture, and fatal cases have been rarely reported. A male in his late forties died right after acupuncture treatment. A medico-legal autopsy disclosed severe haemorrhaging around the right vagus nerve in the neck. Other organs and laboratory data showed no significant findings. Thus, it was determined that the man could have died from severe vagal bradycardia and/or arrhythmia resulting from vagus nerve stimulation following acupuncture. To the best of our knowledge, this is the first report of a death due to vagus nerve injury after acupuncture. PMID:25465674

  18. Dicephalus dipus dibrachius twins: report of an autopsy case

    Directory of Open Access Journals (Sweden)

    Cristiano Claudino Oliveira

    2014-06-01

    Full Text Available Dicephalus dipus dibrachius twins are a rare form of conjoined twins. An autopsy of conjoined dicephalus twins is reported. The diagnosis was performed during the pregnancy and the family received a judicial authorization for termination of pregnancy. The preterm newborn progressed to cardiac arrest and died following a court order to terminate the pregnancy. The conceptus presented two arms, two legs, a trunk, two heads, and a single umbilical cord. The two spinal columns presented vertebral fusion in the sacral region. The heart exhibited complex malformations. The external genitalia were female; and cytogenetic analysis confirmed female sex (46, XX. This analysis also corroborated the etiopathogenic hypotheses described for this abnormality, which proposes failures in embryonic formation rather than specific chromosomal alterations. Current identification of cases by ultrasound permits medical management and multidisciplinary action with the family, enabling the legal termination of pregnancy.

  19. Suicidal hanging in Istanbul, Turkey: 1979-2012 Autopsy results.

    Science.gov (United States)

    Taktak, Safak; Kumral, Bahadir; Unsal, Ayla; Ozdes, Taskin; Buyuk, Yalcin; Celik, Safa

    2015-07-01

    A retrospective study was carried out on 4549 which is the total number of hanging cases autopsied at Forensic Medicine Institute in Istanbul, Turkey. 4502 hanging cases of suicidal origin were detected and evaluated in terms of demographic features, the type of hanging material used for ligature, internal findings in neck organs, toxicological findings and microscopic findings. Of these suicides, 3295 (73.2%) were males and 1207 (26.8%) were females. The average age of the victims was 37.8 (SD 1.6). Crude suicidal hanging rate is approximately two-fold increase in women, while it is about five-to six-fold increase in men during 33 years. 1424 of the victims committed suicide by hanging themselves at home, and 441 of them in prison and indoor areas. The alcohol in the blood of all autopsy victims was tested and results were positive for 687 people. A drug active agent was detected in 108 (2.4%) victims: 70 (1.5%) of them were antidepressants, 20 (0.5%) of them were analgesic/anti-inflammatory/anti-histaminic and 18 (0.4%) of them were antipsychotic. In the examination of the psychoactive substances in blood and urine, any of such substances was not detected in 4146 of the victims. However, victims' blood and urine contained a sedative-hypnotic-anxiolytic with 74 (1.6%), a cannabinoid with 16 (0.4%) and an opioid with 12 (0.3%). Psychoactive substance examination was not carried out for 243 victims. Of these cases, 4060 (90.2%), ecchymosis in soft tissues and 2800 (62.1%) fracture in neck organs was found. PMID:26048496

  20. An autopsy case of pulmonary fissure induced by zygomycosis

    Directory of Open Access Journals (Sweden)

    Imai Y

    2013-07-01

    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

  1. [An autopsied case of presenile dementia with tangles].

    Science.gov (United States)

    Niizato, K; Tsuchiya, K; Nakamura, R; Iritani, S; Ikeda, K; Kosaka, K

    2001-07-01

    We report an autopsied case of presenile dementia showing neuropathologically abundant neurofibrillary tangles(NFT) without senile plaques(tangle only dementia). A Japanese woman developed memory disturbance when she was 60 years old. At age of 65, her ability to understand deteriorated and euphoria and wandering manifested but neither psychotic symptoms, including hallucination and delusion nor a change in character were observed. The patient was hospitalized at age 66 and a cranial CT scan revealed bilateral moderate atrophy of the cortex and moderate enlargement of the lateral ventricle, especially in the inferior horn. No lobar atrophy was detected. She exhibited an oral tendency and became appallic at her final stage and died at the age of 75. Autopsy showed that her brain weighed 850 g and neuropathological study showed numerous NFT mainly in the entorhinal (trans-entorhinal) region, subiculum, CA1-CA4, dentate gyrus, amygdara, subthalamic nucleus, basal nucleus of Meynert, substantia nigra and locus coeruleus. Severe neuronal loss with gliosis was noted in the temporal lobes including the hippocampal region. No senile plaque was detected in any of the brain regions. There have been some recent reports of patients with abundant NFT with the predominant involvement of the allocortex but no or very little senile plaque. All the patients in the reported cases were very elderly at onset(over 80 years of age). In our case, the onset was presenile and we could exclude any other diseases, that usually present with NFT, and to our knowledge, this is the first report of a presenile dementia with tangles. PMID:11517492

  2. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy.

    Science.gov (United States)

    Schulze, Claudia; Hoppe, Hanno; Schweitzer, Wolf; Schwendener, Nicole; Grabherr, Silke; Jackowski, Christian

    2013-12-10

    To evaluate the sensitivity of postmortem computed tomography (PMCT) in rib fracture detection validated against autopsy. Fifty-one forensic cases underwent a postmortem CT prior to forensic autopsy. Two image readers (radiologist and forensic pathologist) assessed high resolution CT data sets for rib fractures. Correct recognition rates (CRR), sensitivity and specificity values were calculated over all observations as well as individually for every rib and region. Additionally, for partial rib fractures the sensitivity of autopsy was calculated vice versa. 3876 entries in each study protocol (autopsy, PMCT radiologist and PMCT forensic pathologist) were investigated. A total of 690 fractures (autopsy), 491 (PMCT and radiologist) and 559 (PMCT and forensic pathologist) were detected. The CRR was 0.85. Sensitivity and specificity of PMCT for rib fracture detection were 0.63 (0.58 radiologist, 0.68 forensic pathologist) and 0.97 (both readers 0.97), respectively. Low CRR and sensitivity values were obtained for antero-lateral fractures. Partial rib fractures were better detected by PMCT. PMCT has a rather low sensitivity for rib fracture detection when validated against autopsy and indicates that clinical CT may also demonstrate a reasonable number of false negatives. Partial rib fractures often remain undetected at autopsy. PMID:24314506

  3. Changing Profile of Autopsied Deaths in the United States, 1972-2007

    Science.gov (United States)

    ... rates versus increasing medicolegal autopsy rates in Halifax, Nova Scotia. Arch Pathol Lab Med 125(7):924– ... M.S., Director File Formats Help: How do I view different file formats (PDF, DOC, PPT, MPEG) on ...

  4. Cause of death among Ghanaian adolescents in Accra using autopsy data

    OpenAIRE

    Tettey Yao; Ohene Sally-Ann; Kumoji Robert

    2011-01-01

    Abstract Background There is limited data on adolescent mortality particularly from developing countries with unreliable death registration systems. This calls for the use of other sources of data to ascertain cause of adolescent mortality. The objective of this study was to describe the causes of death among Ghanaian adolescents 10 to 19 years in Accra, Ghana utilizing data from autopsies conducted in Korle Bu Teaching Hospital (KBTH). Findings Out of the 14,034 autopsies carried out from 20...

  5. The effects of aging on biceps brachii muscle fibers: a morphometrical study from biopsies and autopsies

    OpenAIRE

    Mattiello-Sverzut Ana Cláudia; Chimelli Leila; Moura Maria Silvia de Assis; Teixeira Silvia; Oliveira José Alberto Mello de

    2003-01-01

    OBJECTIVES: In order to study the morphology and size of muscle fibers, cross sections of biceps brachii samples from autopsies, up to 9 hours after death, and biopsies of 72 subjects were compared. The subjects aged 13 to 84 years in both sexes. METHODS: The samples obtained from autopsies (n=47) were from subjects with sudden death, or who died after acute disease without evidence of neuromuscular involvement. The biopsies (n=25) were from patients with symptoms suggestive of inflammatory o...

  6. Academic autopsies in Brazil - a national survey / Autópsias acadêmicas no Brasil - um inquérito nacional

    Scientific Electronic Library Online (English)

    Aloísio, Felipe-Silva; Márcia, Ishigai; Thaís, Mauad.

    Full Text Available Objetivo: Investigar o número e a taxa de autópsias acadêmicas, organização geral, ensino e pesquisa em serviços acadêmicos brasileiros. Métodos: Questionários padronizados enviados para escolas médicas brasileiras (n=177) e programas de residência em patologia ativos (n=53) de março a junho d [...] e 2009. Dados coletados referentes ao período de 2003 a 2008. Resultados: Trinta e dois serviços em 11 estados responderam à pesquisa. Vinte e um (65,6%) realizam menos de cem autópsias de causas naturais e menos de cinquenta autópsias fetais ou pediátricas/ano. Vinte e quatro (75%) realizam menos de cem autópsias de adultos/ano. Muitas instituições (46,9%) relataram queda no número de autópsias em seis anos. A contagem total e a taxa de autópsias em 2008 variaram, respectivamente, de 1 a 632 (mediana=80) e de 0 a 66% (média=10,6%). Foi observada uma redução contínua no total de autópsias em um grupo de 19 instituições (p Abstract in english Objective: To investigate the number and rate of academic autopsies, general organization, educational and research in Brazilian academic services. Methods: Standardized questionnaires were sent to Brazilian medical schools (n=177) and active pathology residency programs (n=53) from March to J [...] une 2009. Data were collected for years 2003 to 2008. Results: Thirty-two academic services in 11 Brazilian states answered the survey. Twenty-one (65.6%) perform less than a hundred autopsies for natural causes and less than fifty pediatric or fetal autopsies/year. Twenty-four (75%) perform less than a hundred adult autopsies/year. Many institutions (46.9%) reported a drop in the number of autopsies in a six-year period. The total autopsy count and autopsy rate in 2008 ranged 1-632 (median = 80), and 0-66% (mean = 10.6%), respectively. A steady decrease in the total count of autopsies in a pool of 19 institutions was observed (p

  7. Chronic Opisthorchis felineus infection attenuates atherosclerosis--an autopsy study.

    Science.gov (United States)

    Magen, Eli; Bychkov, Vitaly; Ginovker, Alexander; Kashuba, Eduard

    2013-09-01

    Previously, we proposed a hypothesis that chronic helminthic infection may have beneficial effects on the development of atherosclerosis. The aim of this study was to investigate an association between Opisthorchis felineus chronic helminthic infections with aortic atherosclerosis and serum total cholesterol. A series of medico-legal autopsy specimens collected in Khanty-Mansiisk (the region in Russia endemic for O. felineus) were studied to assess O. felineus worm burden in cadaver livers. The areas of atherosclerotic lesions in the cadaver aortas were measured by visual planimetry. A family history of cardiovascular disease, smoking, hypertension or diabetes was elicited, and serum total cholesterol levels examined. Three hundred and nineteen cadavers (280 (87.8%) males and 39 (12.2%) females) aged 20-72 years were divided into five age groups: (i) 20-29, (ii) 30-39, (iii) 40-49, (iv) 50-59 and (v) >60 years old. The O. felineus mean worm burden was 257±312 worms/liver. Infected subjects were categorised into three subgroups depending on the worm burden: mild (500 worms). Infected subjects had lower serum total cholesterol (mild worm burden, 186.4±25.6 mg/dl; moderate worm burden, 183.4±23.1mg/dl, P=0.002; severe worm burden, 170.6±25.1mg/dl, P40 years old. Opisthorchis felineus chronic helminthic infectionswas found to be associated with lower serum total cholesterol levels and a significant attenuation of atherosclerosis. PMID:23792298

  8. Intracranial malignant lymphomas. Clinicopathological study of 26 autopsy cases

    International Nuclear Information System (INIS)

    We examined 26 autopsy-proven cases of intracranial malignant lymphoma (IML) in immunocompetent patients to determine the extent of neoplastic involvement of the central nervous system (CNS) and to evaluate the effects of radiation on the tumor and brain tissue. All tumors were identified as diffuse non-Hodgkin's lymphomas of B-cell origin. In six patients who had not received radiotherapy, the clinical course of the disease was short and extensive infiltration of the tumor was seen. The remaining 20 patients were treated with radiotherapy and had a longer survival time. Leptomeningeal involvement was common, but extensive subarachnoid proliferation of the tumor was seen in only two cases. The posterior, but not anterior, lobe of the pituitary was involved in 5 of 22 cases, and choroid plexus involvement was seen in 4 of 21. Direct invasion of the tumor into the spinal cord, which tended to occur in patients with posterior fossa masses, was observed in 5 of 21 cases. Following irradiation, coagulation necrosis was frequently found in the invading zone as well as in the tumor mass, and degeneration of the white matter was also seen. We suggest that IML can extensively infiltrate into the CNS, including the posterior lobe of the pituitary and spinal cord, and that radiation injury to the brain appears to occur relatively easily in this disease. (author)

  9. Hypertrophic cardiomyopathy: an autopsy analysis of 14 cases.

    Directory of Open Access Journals (Sweden)

    Phadke R

    2001-07-01

    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.

  10. Multiple primary cancers among autopsy cases of atomic bomb survivors

    International Nuclear Information System (INIS)

    This is a retrospective analysis of 3121 autopsy cases of A-bomb survivors, done from 1956 through the end of March 1991. According to the distance from the hypocenter, these were divided into (I) A-bomb survivors exposed at ?2000 m (n=549), (II) those exposed at >2,000 m or those who entered the city after A-bombing (n=929), and (III) non-exposed persons (n=1643). The incidence of malignant tumors was lower in the exposed groups than in the non-exposed group. The incidence of multiple cancer was highest in Group I. The exposed groups had a higher incidence of multiple cancer through the whole examination period than the non-exposed group; a quite number of A-bomb survivors were found to have had mutiple cancer even when it was unusual in the general population. There was no definitive correlation between the age at the A-bombing and multiple cancer. In the exposed groups, breast cancer was infrequent and sarcoma was frequent as a composition of multiple cancer. (N.K.)

  11. Autopsy case of double carcinoma arising from Thorotrast administrated patient

    International Nuclear Information System (INIS)

    We report the pathologic and radiologic observations at autopsy of an 85-year-old man with Thorotrastosis due to angiography performed at age 37, and with double carcinoma comprising renal pelvic and gastric carcinoma. Thorotrast deposits were found in the liver, spleen, lymph nodes and bone marrows; the liver showed Thorotrast-induced cirrhosis. Renal pelvic carcinoma and gastric carcinoma were histologically squamous cell carcinoma and tubular adenocarcinoma, moderately differentiated, respectively. Renal pelvic carcinoma had metastasized to the lungs and lymph nodes. On the other hand, no metastasis of gastric carcinoma was detected. These neoplasms seemed unlikely to be in direct association with Thorotrast because there was no Thorotrast deposit in the primary sites. However, there seems to be an intense correlation between Thorotrast carcinogenicity and histologic type of the tumor, because squamous cell carcinoma of the renal pelvis is more frequent in patients with retrograde pyelography with Thorotrast than without Thorotrast. It should be kept in mind that the incidence of carcinoma due to either direct or indirect influence of Thorotrast is high in these patients. (author)

  12. Autopsy pathology in the acquired immune deficiency syndrome.

    Science.gov (United States)

    Reichert, C. M.; O'Leary, T. J.; Levens, D. L.; Simrell, C. R.; Macher, A. M.

    1983-01-01

    The acquired immune deficiency syndrome (AIDS) is a devastating new illness which appears to be sexually and parenterally transmissible. AIDS was first described in the male homosexual community; however, the disease has more recently been described among intravenous drug abusers, Haitians, hemophiliacs, and others. The etiologic agent is unknown. AIDS may represent an infection by a previously undescribed organism, a mutant of a known microorganism, or a multifactorial combination of environmental, immunologic, and genetic factors. As a consequence of the disease's seemingly irreversible ablation of the cell-mediated immune system, AIDS victims succumb to a variety of infections and/or unusual neoplasms. In its fully developed form, mortality approaches 100%. At autopsy the gross and microscopic pathology of the syndrome can be divided into three general categories: 1) morphologic manifestations of profound lymphoid depletion; 2) infections, usually with mixed opportunistic pathogens; and 3) unusual neoplasms, most frequently Kaposi's sarcoma or high-grade lymphomas. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 PMID:6311021

  13. The uses and value of autopsy in medical education as seen by pathology educators.

    Science.gov (United States)

    Hill, R B; Anderson, R E

    1991-02-01

    A national meeting of pathology educators in 1989 provided the impetus for an exploration of new uses of autopsy in medical education. A month before the conference, the authors sent a questionnaire about the uses and value of autopsy in medical education to 120 persons registered to attend the conference. They used the 98 responses, representing 69 U.S. and Canadian medical schools, as the basis of a workshop on the place of autopsy in future medical education. The present article is a report of the authors' findings from the questionnaire and workshop. They found that the uses of autopsy go far beyond the traditional uses in teaching clinical pathophysiology, clinico-pathologic correlations, clinical anatomy, gross and microscopic anatomy of disease, and visual skills. Emphasis was placed on the potential role of autopsy in education regarding legal/judicial proceedings, vital statistics, epidemiologic investigations, and public health, and in the understanding of such complex matters as medical fallibility, medical uncertainty, and grief. These purposes were seen as congruent with current societal concerns about the need to reverse the trend toward dehumanization of medicine and physicians. The inability to realize these aims in the face of a precipitous drop in the autopsy rate is discussed. PMID:1993112

  14. Autopsy rate in suicide is low among elderly in Denmark compared with Finland

    DEFF Research Database (Denmark)

    Ylijoki-SØrensen, Seija; Boldsen, Jesper Lier

    2014-01-01

    National differences in the legislation on cause and manner of death investigation are reflected in a high autopsy rate in suicides in Finland and a low corresponding rate in Denmark. The consequences for mortality statistics of these different investigation practices on deaths classified as suicides in Denmark and Finland, respectively, are not known in detail. The aim of this article was to analyse autopsy rates in deaths classified as suicides, and to identify any differences in investigation practices in deaths with a comparable cause of death, but classified as unnatural deaths other than suicide. Data from the mortality registries were summarised for the years 2000, 2005 and 2010. Autopsy rates (total, forensic and medical) were analysed with regard to deaths classified as suicide, and they were compared for three age groups (1-50 years, 51-70 years and ?71 years) and for causes of death. Deaths classified as suicide were compared with other unnatural classifications, and comparable causes of death werecoded into six subgroups: poisonings, suffocations/strangulations, firearm discharges, drowning/submersions, explosions/flames and other/unspecified causes. The total autopsy rate for suicides was 99.8% in Finland and 13.2% in Denmark. Almost all of these autopsies were conducted as forensic autopsies. In the age group ?71 years, Danish suicides outnumbered Finnish suicides (410 versus 283). The total autopsy rate was lower in the more senior age group in Denmark (19.5%, 9.9%, 5.6%), whereas it was consistently high in Finland (99.8%, 99.9%, 99.6%). Among Danish deaths due to poisonings, the autopsy rate was 89.5% when these were classified as accidents, but only 20.7% for cases classified as suicides. The number of deaths in the two Danish subgroups was comparable (550 versus 553). In Denmark, the decision regarding the need, if any, for a forensic autopsy is made during the external forensic examination of the body. Our study showed that the limited use of forensic autopsy to confirm the cause of death in deaths classified as suicides raises doubts about the accuracy of the Danish suicide mortality statistics. Our finding is emphasised by those cases in which the cause of death was registered as intentional self-poisoning. The high number of suicides among the elderly in Denmark is striking and begs further investigation and research. Overall, our data from Finland and Denmark reveal striking differences between the two countries and warrant further comparative studies on the subject in other countries.

  15. Coronary atherosclerosis in sudden cardiac death: An autopsy study

    Directory of Open Access Journals (Sweden)

    Sudha M

    2009-10-01

    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.

  16. Utility of desmin and a Masson's trichrome method to detect early acute myocardial infarction in autopsy tissues

    OpenAIRE

    Ouyang, Jie; Guzman, Miguel; Desoto-lapaix, Fidelina; Pincus, Matthew R.; Wieczorek, Rosemary

    2010-01-01

    Detection of early acute myocardial ischemia/infarction prior to neutrophilic infiltration in autopsy myocardium poses a diagnostic dilemma to the surgical pathologist. Morphological changes can be subtle or not identified at all on the hematoxylin and eosin stain. To evaluate the Masson's trichrome stain and immunohistochemical stains, desmin and myoglobin, in detecting acute myocardial ischemia/infarction in autopsy myocardium. We reviewed the autopsy files of the New York Harbor Healthcare...

  17. Pulmonary Calciphylaxis Associated with Acute Respiratory and Renal Failure Due to Cryptogenic Hypercalcemia: An Autopsy Case Report

    OpenAIRE

    Kim, Na Rae; Seo, Jin Won; Lim, Young Hwan; Ham, Hyoung Suk; Huh, Wooseong; Han, Joungho

    2012-01-01

    Metastatic calcification is rare; it is found during autopsy in patients who underwent hemodialysis. Diffuse calcium precipitation of small and medium-sized cutaneous vessels, known as calciphylaxis, can result in progressive tissue necrosis secondary to vascular calcification. This condition most commonly involves the skin; however, a rare occurrence of visceral calciphylaxis has been reported. Here we report on an autopsy case. Despite a thorough evaluation, and even performing an autopsy, ...

  18. The use of CT-scanning at the medicolegal external postmortem examination and at the forensic autopsy

    DEFF Research Database (Denmark)

    Leth, Peter Mygind

    2006-01-01

    Introduction: Can CT-scanning of deceased at the medico legal external examination improve the selection of cases to autopsy? Is CT-scanning a substitute or a supplement to the traditional forensic autopsy? Material: In 2006 60 deceased individuals from Southern Denmark (counties of Fyn and Sønderjylland) (15 females and 45 males) were CT-scanned before autopsy. Method: A double-blind prospective investigation of CT-scanning in autopsy cases. A multislice spiral CT-scanner (Siemens Somatom Spirit) was used. Data from the CT-scanning and the autopsy were registered in a computer database and compared. Results: The scanning could be performed in 10 minutes per case. In approximately a third of the cases the cause of death could be established by CT-scanning alone. CT-scanning was found to be most useful in cases of traumatic death, and was superior to autopsy in visualizing fractures. Conclusions: CT-scanning is not a substitute for autopsy, but can be used at the medico legal external examination to evaluate in which cases an autopsy is needed. It can also be used as a supplement to the autopsy in cases of traumatic death, and is especially useful in evaluation of injuries sustained in motor vehicle accidents and in gunshot injuries, and for identification purposes.  

  19. Verbal autopsy: current practices and challenges / Autopsie verbale: pratiques actuelles et défis à surmonter / Autopsias verbales: práctica y retos

    Scientific Electronic Library Online (English)

    Nadia, Soleman; Daniel, Chandramohan; Kenji, Shibuya.

    2006-03-01

    Full Text Available Los datos sobre causas de defunción obtenidos a partir de autopsias verbales (AV) son usados con creciente frecuencia con fines de planificación de la salud, establecimiento de prioridades, seguimiento y evaluación en los países con sistemas de registro civil incompletos o inexistentes. En algunas r [...] egiones del mundo es el único método disponible para poder estimar la distribución de las causas de mortalidad. Hoy día el método de las AV se utiliza sistemáticamente en más de 35 lugares, sobre todo en África y Asia. En este artículo presentamos un panorama general del sistema de las AV y los resultados de un análisis de los instrumentos de AV y los procedimientos operativos utilizados en los sitios de vigilancia demográfica y los sistemas de registro de estadísticas vitales por muestreo. Solicitamos información a 36 sitios sobre el terreno acerca de los procedimientos operativos y examinamos 18 cuestionarios de autopsia verbal y 10 listas de causas de defunción usadas en 13 países. El formato y el contenido de los cuestionarios de AV, los procedimientos operativos sobre el terreno, las listas de las causas de defunción y los procedimientos empleados para calcular las causas de mortalidad a partir de las AV diferían sustancialmente de un sitio a otro. Analizamos las consecuencias de utilizar distintos métodos y llegamos a la conclusión de que es necesario normalizar los instrumentos y los procedimientos de AV y hacerlos más fiables si se desea hacer comparaciones más precisas de los datos de AV en los planos nacional e internacional. Ponemos de relieve, además, las medidas adicionales que habría que adoptar para desarrollar un procedimiento de AV normalizado. Abstract in english Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribut [...] ion of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process.

  20. Comparison of clinical causes of deth with autopsy diagnosis using discrepancy classification

    International Nuclear Information System (INIS)

    To determine the usefulness of autopsy findings in the quality improvement of patients care. The clinical and necropsy findings of all the cases, who died in hospital and had undergone autopsy examination at CMH, Kharian, from January 2001 to December 2003, were retrieved from record of clinical case sheet data and autopsy record of the hospital. The two were analyzed and compared according to the discrepancy classification. The exclusion and inclusion criteria, the international classification of disease (ICD) to code deaths, the global burden of disease (GBD) system to classify and group diseases, and the Goldman discrepancy classification to compare clinical and autopsy diagnosis and classify the discrepancies, were used as described. The death rate varied from 0.94% to 1.29% and autopsy rate from 4.69% to 10.10% annually between January 2001 and December 2003. The number of cases classified according to GBD system was 3 (5%) in Group 1, 26 (43.33 %) in Group 2 and 31 (51.66 %) in Group 3. The discrepancy classes included 9 (15 %) class I major discrepancies and 3 (5 %) class II major discrepancies. Non-discrepant diagnosis was seen in 37 cases (61.66 %) and 11 cases (18.32 %) were non classifiable. (author)

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

    Science.gov (United States)

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

    2010-01-01

    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

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

    International Nuclear Information System (INIS)

    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)

  3. Radiography after unexpected death in infants and children compared to autopsy

    International Nuclear Information System (INIS)

    Postmortem radiography may reveal skeletal and soft-tissue abnormalities of importance for the diagnosis of cause of death. To review the radiographs of children under 3 years of age who had died suddenly and unexpectedly. To compare the radiological and autopsy findings evaluating possible differences in children dying of SIDS and of an explainable cause. A total of 110 consecutive skeletal surveys performed between 1998 and 2002 were reviewed. All but one were performed before autopsy and comprised AP views of the appendicular and axial skeleton and thorax/abdomen, lateral views of the axial skeleton and thorax, and two oblique views of the ribs. Radiography and autopsy findings were compared. Causes of death were classified as SIDS/borderline SIDS (n = 52) and non-SIDS (n = 58), with one case of abuse. In 102 infants there were 150 pathological findings, 88 involving the chest, 24 skeletal, and 38 miscellaneous findings. The radiological-pathological agreement was poor concerning pulmonary findings. Skeletal findings were sometimes important for the final diagnosis. Radiography revealed many skeletal and soft-tissue findings. Pulmonary pathology was most frequently found, but showed poor agreement with autopsy findings. Recognizing skeletal findings related to abuse is important, as these may escape recognition at autopsy. (orig.)

  4. Evaluation of Fetal Autopsy Findings in the Hatay Region: 274 Cases

    Directory of Open Access Journals (Sweden)

    Sibel HAKVERD?

    2012-05-01

    Full Text Available Objective: The aim of this study was to present the incidence of fetal anomalies in our region of Hatay, Turkey in order to determine the efficiency of prenatal diagnosis through fetal autopsy, and to compare our statistical data with other national and international studies.Material and Method: This study was conducted on 274 fetuses from terminated pregnancies due to abnormal prenatal findings and intrauterine deaths from 2005 to September 2010. Fetuses were evaluated through postmortem examination, external measurements, X-rays, Magnetic Resonance Images, Multislice Computerized Tomography and photographs. The autopsy was completed by the histological examination of each organ.Results: Autopsy was conducted on 274 fetuses. A fetal anomaly was detected in 160 (58.39% cases. The central nervous system contained the most frequent structural defects (79 cases, 49.38%, followed by malformations in the musculoskeletal system in 36 cases (22.5%. The most frequent multiple system anomalies were central nervous system defect and bilateral adrenal agenesis, musculoskeletal system malformations and urinary system defects. Fetal autopsy provided additional findings in 43 cases (26.88%.Conclusion: Fetal autopsy is a very important procedure and an integral part of the general prenatal management. New findings through this method may suggest invaluable data for parents about potential risks in future pregnancies.

  5. Forensic autopsy practice in the Middle East: Comparisons with the west.

    Science.gov (United States)

    Al-Waheeb, Salah; Al-Kandary, Nadia; Aljerian, Khaldoon

    2015-05-01

    Autopsies are performed in the majority of Arab, Muslim countries. Several of these countries face social challenges and others do not have well established academic programs to teach the science. In this article we intend to review the history and practice of the forensic part of autopsies in a few Arab, Muslim countries (Egypt, Kingdom of Saudi Arabia (KSA) and Kuwait) and compare it with the United States of America (USA) and the United Kingdom (UK), 2 countries where the practice of forensic science and Forensic pathology is well established. This was achieved by pub med literature search and the distribution of a questionnaire to colleagues in Arab countries. We recommend that Arab countries explore the field of virtual autopsy to overcome some of the social challenges related to dissection of the cadaver. Kuwait can benefit from the introduction of Forensic training given the high workload in the country. PMID:25882141

  6. Sudden unexplained death in childhood. An audit of the quality of Autopsy reporting

    LENUS (Irish Health Repository)

    Treacy, A

    2013-03-01

    Cases of sudden unexplained death in childhood (SUDC) in Ireland in children aged >1year and <5 years were examined in order to assess the quality of autopsy reporting. All SUDC cases are notified to and documented by the National Sudden Infant Death Register (NSIDR) in Ireland along with all cases of sudden infant death syndrome (SIDS) referring to sudden infant deaths less than one year of age. The database of the NSIDR in Ireland was interrogated and cases of SIDS and SUDC were compared over a fifteen-year period (1995-2009). SIDS cases whose autopsies were conducted in the same hospital in the same year as the index SUDC case were used for comparison. The autopsy report for each case was examined and modified Rushton(MR) scores 1\\r\

  7. [Soft tissue-cutting law, i.e. the career concept of an autopsy assistant].

    Science.gov (United States)

    Kormos, Timea; Csatai, Tamás; Jäckel, Márta

    2015-03-01

    Practical experience shows that the autopsy assistant society is fairly divided. There are some people who would have needed a thorough basic training, and there are those who - due to their diligence and the close cooperation with physician colleagues - would deserve an opportunity for further progress due to their extensive knowlegde. As regards the autopsy assistant profession the training, and the training system as well has changed significantly, and it requires further changes. Examining the issue in a wide spectrum, the aim of the authors is, as much as possible, to promote the formation of an "Autopsy assistant career," in which they want to create a predictable way for the members of the profession from the phase of becoming a student (competency, training, exams, vocational training, single note) to obtaining the master's degree. The authors would like to provide a summary about their experience and plans regarding this issue. PMID:25726768

  8. 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.)

  9. Verbal autopsy of 80,000 adult deaths in Tamilnadu, South India

    Directory of Open Access Journals (Sweden)

    Peto Richard

    2004-10-01

    Full Text Available Abstract Background Registration of the fact of death is almost complete in the city of Chennai and not so in the rural Villupuram district in Tamilnadu, India. The cause of death is often inadequately recorded on the death certificate in developing countries like India. A special verbal autopsy (VA study of 48 000 adult (aged ? 25 yrs deaths in the city of Chennai (urban during 1995–97 and 32 000 in rural Villupuram during 1997–98 was conducted to arrive at the probable underlying cause of death to estimate cause specific mortality. Methods A ten day training on writing verbal autopsy (VA report for adult deaths was given to non-medical graduates with at least 15 years of formal education. They interviewed surviving spouse/close associates of the deceased to write a verbal autopsy report in local language (Tamil on the complaints, symptoms, signs, duration and treatment details of illness prior to death. Each report was reviewed centrally by two physicians independently. Random re-interviewing of 5% of the VA reports was done to check the reliability and reproducibility of the VA report. The validity of VA diagnosis was assessed only for cancer deaths. Results Verbal autopsy reduced the proportion of deaths attributed to unspecified and unknown causes from 54% to 23% (p Conclusion A ten day training programme to write verbal autopsy report with adequate feed back sessions and random sampling of 5% of the verbal autopsy reports for re-interview worked very well in Tamilnadu, to arrive at the probable underlying cause of death reliably for deaths in early adult life or middle age (25–69 years and less reliably for older ages (70+. Thus VA is practicable for deaths in early adult life or middle age and is of more limited value in old age.

  10. Proliferating cell nuclear antigen. A marker for cell proliferation in autopsy tissues.

    Science.gov (United States)

    Isik, F F; Ferguson, M; Yamanaka, E; Gordon, D

    1992-11-01

    Antibodies to the proliferating cell nuclear antigen allow identification of proliferating cells in fresh tissue specimens using routine immunocytochemical methods. However, the use of such proliferation markers has not been verified for autopsy-derived tissue specimens, in which there is often a significant delay between the time of death and tissue specimen fixation. To assess the reliability of anti-proliferating cell nuclear antigen antibodies to identify proliferating cells in autopsy tissue specimens, an autopsy simulation was performed using fresh monkey and rat tissue specimens. These tissue specimens were kept at room temperature for predetermined numbers of hours before fixation. The proliferation specific staining was most reliable for tissue specimens obtained within 6 hours of death. There was reliable staining of proliferating regions up to 12 hours, although sensitivity was decreased. The only exception was skin, which was able to withstand much longer periods. Quantitative data from monkey spleen white-pulp regions showed 63% of the cells to stain for proliferating cell nuclear antigen when fixed immediately; this decreased to 29% of the cells after 12 hours and only 19% by 18 hours of postmortem simulation. Representative tissue specimens obtained from human autopsy material revealed similar postmortem staining patterns. Rapid procurement and fixation of tissue specimens and the use of control tissue specimens derived from the same autopsy material (eg, lymph node tissue) are recommended. These studies do suggest that anti-proliferating cell nuclear antigen antibodies can be used to identify proliferating cells in human autopsy tissue specimens obtained within approximately 12 hours of death, with some compromise in overall sensitivity. PMID:1280077

  11. Psychological autopsies: the current Department of Defense effort to standardize training and quality assurance.

    Science.gov (United States)

    Ritchie, Elspeth Cameron; Gelles, Michael G

    2002-11-01

    Psychological autopsies have been gathered by the US military for a long time, both for lessons learned after a known suicide and to investigate an equivocal death. The term "psychological autopsies" is now being restricted to define an investigation by mental health to help determine, in an equivocal death, if the manner of death is a homicide, suicide, an accident, or from natural causes. The Department of Defense has developed policy, and is now implementing training and peer review. A sample model curriculum, report format and quality assurance standards are included. PMID:12455666

  12. Autopsy report on central pontine myelinolysis triggered by vomiting associated with digoxin intoxication.

    Science.gov (United States)

    Unuma, Kana; Harada, Kazuki; Nakajima, Makoto; Eguchi, Hiromi; Tsushima, Kensuke; Ito, Takako; Shintani-Ishida, Kaori; Kojima, Hideaki; Yoshida, Ken-ichi

    2010-01-30

    An 87-year-old male, prescribed digoxin and furosemide for congestive heart failure and Alzheimer disease, had dehydration and anemia due to poor food intake and hemorrhagic cystitis. Repeated vomiting due to an upper respiratory infection caused disturbance of consciousness and hypotension. The patient was admitted to hospital and diagnosed with digoxin intoxication and hypernatremia. The serum sodium (Na(+)) level was corrected, but the patient died 4 days after admission following uncontrollable seizure. A histologic examination after an autopsy revealed characteristic findings of central pontine myelinolysis (CPM). This is the first autopsy report on CPM triggered by vomiting in association with digoxin administration. PMID:19786335

  13. Validity of the European short list of respiratory diseases: a 40-year autopsy study.

    Science.gov (United States)

    Gulsvik, Anne K; Henriksen, Andreas H; Svendsen, Einar; Humerfelt, Sjur; Gulsvik, Amund

    2015-04-01

    The predictors of autopsy and the accuracy of European short list (E) codes of respiratory diseases lack recent knowledge. A 10% random sample (n=6811) of inhabitants of Bergen, Norway, aged 20-70 years, was invited to participate in a survey in 1965-1971 (participation rate 83%). By December 31, 2005, 4387 (64%) participants had died and 1163 (27% of the deceased) had been given an autopsy. Causes of death were tuberculosis (E02, 0.2%), lung malignancy (E15, 3.5%), influenza (E38, 0.2%), pneumonia (E39, 6.5%) and chronic lower respiratory diseases (E40, 3.2%). Male sex, early deaths in the surveillance period and E15 were positive predictors of an autopsy examination, whereas old age and E39 were strong negative predictors. Among those referred for a post mortem examination, the cause of death was verified as tuberculosis in 0.3%, lung cancer in 8.1%, acute pneumonia in 2.0% and chronic obstructive lung diseases in 4.9%. Cohen's kappa coefficients (E codes versus autopsy) were 0.91 (95% CI 0.86-0.96) for E15, 0.37 (95% CI 0.20-0.54) for E39 and 0.65 (95% CI 0.54-0.76) for E40. These findings matter when deaths from respiratory diseases are used as end-points in epidemiological association studies and clinical trials. PMID:25359344

  14. Demonstration of iron and thorium in autopsy tissues by x-ray microanalysis

    International Nuclear Information System (INIS)

    We performed x-ray microanalysis of autopsy specimens using a scanning-transmission electron microscopy mode. Tissues were obtained at necropsy from a patient with history of angiography using thorium dioxide and from a patient with hemochromatosis. X-ray microanalysis confirmed the presence of thorium and iron in their respective tissues. Effects of staining reagents were examined

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

    Directory of Open Access Journals (Sweden)

    Kochhar Rakesh K

    2009-12-01

    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.

  16. Marfan syndrome and sudden death within a family - aetiologic, molecular and diagnostic issues at autopsy.

    Science.gov (United States)

    Hirani, Rena; Koszyca, Barbara; Byard, Roger W

    2008-05-01

    Although Marfan syndrome has a range of characteristic morphological features involving the ocular, cardiovascular and musculoskeletal systems, the phenotype is variable. In addition, mutations have been identified in the gene encoding for fibrillin-1 and also in the transforming growth factor-beta receptor 2 (TGF-betaR2) gene. Two cases are presented of sudden and unexpected deaths in cousins who manifested morphologic features of Marfan syndrome at autopsy. Case 1: A 36-year-old male who collapsed and was found at autopsy to have arachnodactyly, a high arched palate and lethal aortic dissection with haemopericardium. Case 2: A 34-year-old male who collapsed and was found at autopsy to have arachnodactyly, a high arched palate, pes cavus and a dysplastic mitral valve. Current aetiological theories and molecular findings are discussed. While family follow-up and counselling are advised when cases come to autopsy, given the variability in phenotype and genotype, and the difficulties that exist in attempting to determine clinical prognosis from either of these, such deaths may raise more concerns for surviving family members than providing answers. PMID:18423350

  17. Retrospective study of adenovirus in autopsied pulmonary tissue of pediatric fatal pneumonia in South China

    Directory of Open Access Journals (Sweden)

    Gong Si-Tang

    2008-09-01

    Full Text Available Abstract Background Adenovirus are the important pathogen of pediatric severe pneumonia. The aim of this study is to analyze the infection, subtype and distribution of adenovirus in autopsied pulmonary tissue of fatal pneumonia in infants and children, and the relationships between adenovirus infection and respiratory illness in South China. Methods Nested PCR was performed on DNA extracted from autopsied lung tissue from patients who died of severe pneumonia, and the positive nested PCR products were cloned and sequenced. The adenovirus in autopsied pulmonary tissue was also analyzed by immunohistochemistry assay in a blind way. Results In the 175 autopsied pulmonary tissues, the positive percentage of adenovirus was 9.14% (16/175 and 2.29% (4/175 detected with nested PCR and immunohistochemistry, respectively. There are three cases of adenovirus serotype 3, twelve cases of adenovirus serotype 4 and one case of serotype 41 determined by sequencing of the cloned positive nested PCR products. Conclusion Adenovirus is an important cause of severe pneumonia, and these data suggest that adenovirus serotype 4 might be an important pathogen responsible for the fatal pneumonia in Guangzhou, South China.

  18. ALZHEIMERS DISEASE - HISTOLOGICAL ULTRASTRUCTURAL AND IMMUNOCHEMICAL STUDY OF AN AUTOPSY PROVEN CASE

    OpenAIRE

    Shankar, S. K.; Chandra, Prabha S.; Rao, T. Vasudev; Asha, T.; Sagar, B. Chandrasekhar; Das, Sarala; Channabasavanna, S. M.

    1988-01-01

    We report a detailed morphological, ultrastructural and immunochemical features of neuronal pathology in a case of Alzheimer's disease. This is probably the first detailed study of an autopsy confirmed case from India. The features noted are similar to the ones described from the West.

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

    Science.gov (United States)

    Tag, B

    2011-11-01

    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. PMID:21805100

  20. The Missing Piece: A Sociological Autopsy of Firearm Suicide in the United States

    Science.gov (United States)

    Slater, Greta Yoder

    2011-01-01

    Social, economic, violence, political, and gun access predictors of suicide and gun suicide were examined via sociological autopsy. The model predicting suicide rates overall had the best results, X[superscript 2](9, N = 50) = 5.279 (CMIN, the goodness of fit statistic that represents the minimum discrepancy between the unrestricted sample…

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

    Directory of Open Access Journals (Sweden)

    Wallace Dennis

    2011-08-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Misganaw Awoke

    2012-08-01

    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.

  3. An autopsy case of thyroid cancer following radiotherapy for tongue cancer

    International Nuclear Information System (INIS)

    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. (Tsunoda, M.)

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

    Directory of Open Access Journals (Sweden)

    Nakanishi,Kuniaki

    2009-12-01

    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.

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

    DEFF Research Database (Denmark)

    Slot, Liselott Kristina; Larsen, Peter Kastmand

    2014-01-01

    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. © 2013 American Academy of Forensic Sciences.

  6. Photogrammetric documentation of regions of interest at autopsy--a pilot study

    DEFF Research Database (Denmark)

    Slot, Liselott; Larsen, Peter K

    2014-01-01

    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.

  7. Myocardial abscess as a complication of an infected arteriovenous fistula: autopsy report

    Directory of Open Access Journals (Sweden)

    Cristiane Rúbia Ferreira

    2011-09-01

    Full Text Available Myocardial abscess is a severe and life-threatening infectious complication thatis commonly but not exclusively associated with infective endocarditis. It mayalso be developed in necrotic myocardial tissue, post trauma, in septic burnpatients, in transplanted heart, in ventricular aneurysm and post angioplasty.Patients on hemodialysis are prone to bacteremia, and infectious complicationsoccur in 48-73% of cases. Myocardial abscess is a rare complication of aninfected arteriovenous fistula. We present an autopsy report of a hemodialysispatient who had an arteriovenous fistula with a polytetrafluoroethylene graftwhere a local infection developed. The patient presented with fever and toxemia.On post-admission day 2, he unexpectedly suffered sudden cardiopulmonaryarrest and died. The autopsy revealed a myocardial abscess, near a branch ofthe left coronary artery, with septic embolism.

  8. Photogrammetric Documentation of Regions of Interest at Autopsy—A Pilot Study

    DEFF Research Database (Denmark)

    Slot, Liselott; Larsen, Peter K

    2014-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Todorovi? Miloš S.

    2011-01-01

    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.

  10. Death due to sickle cell anaemia, an autopsy diagnosis: a study at a tertiary care hospital

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    Hemali J. Tailor

    2015-04-01

    Full Text Available Background: Sickle cell disease (SCD is the generic term for the group of inherited haemoglobinopathies caused by the occurrence of Haemoglobin S (HbS in the homozygous or heterozygous form in combination of Hbs with another abnormal haemoglobin such as HbSC or beta-thalassaemias (HbS-thal. Sickle cell syndromes are remarkable for their clinical heterogeneity, including their presentations as sudden and unexpected deaths due to a sickle cell crisis. Less numbers of deaths are reported due to this cause because of ignorance of autopsy surgeon in considering this disease as a cause of death despite of its high prevalence. While doing autopsy in cases of deaths with no apparent cause and physical over activity medical officer must keep in mind the possibility of death due to vaso-occlusive crisis in sickle cell disease. Methods: The study covers a period of one year (January 2013 - December 2013 and it is a study of cases of autopsy carried out in a tertiary care hospital of South Gujarat. Results: A total of 607 cases examined, out of which sickled red blood cells were detected in 17 cases. The respective records were reviewed. Out of 17 cases, 13 cases were male and 4 cases were females. The youngest person was 15 years female and oldest was 70 years male. Conclusion: Sickle cell crisis is one of the causes of sudden unexplained deaths. The present study highlights the role of autopsy in such cases. Community awareness and marriage counseling programs are also helpful in preventing sickle cell disease. [Int J Res Med Sci 2015; 3(4.000: 944-947

  11. An analytical method for the determination of plutonium in autopsy samples

    International Nuclear Information System (INIS)

    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

  12. Concordancia entre el diagnóstico clínico y el patológico por necropsias Clinico-pathological concordance at autopsies

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    EDITH VALDEZ-MARTÍNEZ

    1998-01-01

    Full Text Available Objetivo. Determinar la concordancia entre diagnósticos clínicos y patológicos con base en los resultados de necropsias. Material y métodos. Se revisaron 67 protocolos de necropsia y expedientes clínicos de niños y adultos del servicio de patología del Centro de Especialidades Médicas del Estado de Veracruz Doctor Rafael Lucio, durante 1995 y 1996. Se obtuvieron las frecuencias simples de las variables de estudio, y la concordancia se calculó con el estadístico kappa simple. Resultados. En general la cifra de necropsias fue de 10.5%. Correspondió a la población infantil la mayor frecuencia (17.5%. El 59% de diagnósticos clínicos en niños y el 57% en adultos presentaron algún tipo de error La concordancia del diagnóstico principal ante y postmortem fue de 26% (infantes y 41% (adultos. Conclusiones. La alta cifra de errores diagnósticos y la consecuente baja concordancia clínicopatológica apoyan el hecho de que, a pesar del avance tecnológico en los procedimientos diagnósticos, es necesario realizar necropsias con el fin de documentar de manera más definitiva el control de calidad del ejercicio de la medicina.Objective. To determine the degree of concordance between clinical and autopsy diagnosis. Material and methods. The records of 67 autopsies and clinical files of children and adults, comprising the years 1995 to 1996, from a third level hospital in the State of Veracruz, Mexico, were revised. The concordance score was calculated with the statistical kappa. Results. In general, the rate of autopsy was 10.5%, with higher frequency for children (17.5%. In children, 59% of clinical diagnoses revealed mistakes and in adults, 57%. The degree of agreement in the underlying cause ante and postmortem was 6% in children and 41% in adults. Conclusions The high rate of diagnostic error and low concordance score between clinical and autopsy diagnosis strongly suggests that, in spite of increased availability of modern diagnostic techniques, the necessity of postmortem studies to control the level of medical practice is evident.

  13. Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death

    OpenAIRE

    Salge Ana Karina Marques; Castro Eumenia Costa da Cunha; Ferraz Mara Lúcia Fonseca; Reis Marlene Antônia dos; Teixeira Vicente de Paula Antunes

    2004-01-01

    PURPOSE: The purpose of this study was to identify the possible alteration in the thickness of the epithelium basal membrane of the vocal cords and correlate it with the cause of death. METHOD: Larynxes collected from adult autopsies during the period of 1993 to 2001 were utilized. We used the hematoxylin-eosin and periodic acid-Schiff staining methods for the morphological and morphometric analysis. RESULTS: Sixty-six vocal cords were analysed; increased thickness was identified in 14 cases ...

  14. Plasma homocysteine, Alzheimer and cerebrovascular pathology: a population-based autopsy study

    OpenAIRE

    Hooshmand, Babak; Polvikoski, Tuomo; Kivipelto, Miia; Tanskanen, Maarit; Myllykangas, Liisa; Erkinjuntti, Timo; Mäkelä, Mira; Oinas, Minna; Paetau, Anders; Scheltens, Philip; van Straaten, Elizabeth C W; Sulkava, Raimo; Solomon, Alina

    2013-01-01

    Elevated plasma total homocysteine is associated with increased risk of dementia/Alzheimer’s disease, but underlying pathophysiological mechanisms are not fully understood. This study investigated possible links between baseline homocysteine, and post-mortem neuropathological and magnetic resonance imaging findings up to 10 years later in the Vantaa 85+ population including people aged ?85 years. Two hundred and sixty-five individuals had homocysteine and autopsy data, of which 103 had po...

  15. InSilicoVA: A Method to Automate Cause of Death Assignment for Verbal Autopsy

    OpenAIRE

    Clark, Samuel J.; Mccormick, Tyler; Li, Zehang; Wakefield, Jon

    2015-01-01

    Verbal autopsies (VA) are widely used to provide cause-specific mortality estimates in developing world settings where vital registration does not function well. VAs assign cause(s) to a death by using information describing the events leading up to the death, provided by care givers. Typically physicians read VA interviews and assign causes using their expert knowledge. Physician coding is often slow, and individual physicians bring bias to the coding process that results i...

  16. Mesenteric volvulus in children: two autopsy cases and review of the literature

    International Nuclear Information System (INIS)

    Small bowel mesenteric volvulus when compared with mesocolonic volvulus, have not high incidence. Two autopsy cases of small bowel mesenteric volvulus in infants, highlighting the importance of a suspicion in early recognition of this rare but potentially fatal intra-abdominal emergency are reported. We also review the literature on possible aetiologies and mechanism of small bowel mesenteric volvulus, as well as its management. (author)

  17. Memories of an Autopsy: The Effects of Stress Exposure on Suggestibility for a Stressful Event

    OpenAIRE

    Elisa Krackow; Vanessa M. Jacoby; Scotti, Joseph R.

    2013-01-01

    The current study examined the effects of stressful life events on memory for a stressful event. Two groups ofcollege students (N = 61) were formed for analysis based on the presence or absence of particular stressful lifeevents. Participants then viewed a graphic video depicting an autopsy, and received a memory interview fourdays later. Results showed similar group performance on correctly leading questions. However, participants inthe Specific Stressor-Exposed group were less suggestible t...

  18. Word Root Translation of 45,564 Autopsy Reports into MeSH Titles

    OpenAIRE

    Moore, G. William; Hutchins, Grover M.; Boitnott, John K; Miller, Robert E.; Polacsek, Richard A.

    1987-01-01

    It has become increasingly cost-effective to produce primary medical records as electronic documents. However, access to these documents by disease-concept is limited by the user's knowledge of the classification system (ICD, SNOMED, MeSH). We have developed a system of algorithmic translation between medical natural language and MeSH titles, by respelling common word roots. Using the list of 17,494 words harvested from all autopsies performed at The Johns Hopkins Hospital between May 28, 188...

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

    OpenAIRE

    Ohno Summer; Neal Bruce; Mehta Saurabh; Lucero Marilla; Lozano Rafael; Kumar Vishwajeet; Kumar Aarti; Kalter Henry; Joshi Rohina; Hernández Bernardo; Gómez Sara; Flaxman Abraham D; Fawzi Wafaie; Dutta Arup; Dhingra Usha

    2011-01-01

    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 s...

  20. Identification of Novel Missense Mutations of Cardiac Ryanodine Receptor Gene in Exercise-Induced Sudden Death at Autopsy

    OpenAIRE

    Creighton, Wendy; Virmani, Renu; Kutys, Robert; Burke, Allen

    2006-01-01

    Mutations in the cardiac ryanodine type 2 receptor (RyR2) gene are associated with catecholaminergic polymorphic ventricular tachycardia. We hypothesized that these mutations could be detected at autopsy in cases of exercise-triggered sudden death. Fourteen sudden death patients, eight males and six females, were studied at autopsy based on apparent sudden cardiac death, without significant anatomical abnormalities. The coding regions of arrhythmia genes were amplified by polymerase chain rea...

  1. A prospective study of paediatric autopsies conducted at Bapuji Hospital and Research Centre, Davangere.

    Directory of Open Access Journals (Sweden)

    Santhosh Chandrappa Siddappa

    2014-02-01

    Full Text Available Pediatrics is the branch of medicine dealing with children and their diseases. Injury & Violence are major killers of children and adolescents under the age of 18 years throughout the world, and are responsible for about 950000 deaths each year. Unnatural childhood deaths are not only associated with intense trauma and separation distress, but also relate to a sense of self neglect to protect children from harm. Out of 532 autopsies performed during the study period from January 2010 to December 2013, 87 victims belongs to the pediatric age group, were autopsied at the Department of Forensic Medicine & Toxicology at J.J.M.Medical College’s, Bapuji hospital and Research center, Davangere.The purposes of this study were to report the autopsy findings of unnatural child deaths, and to identify the prevalence of specific factors such as age, sex, postmortem findings, cause of death and manner of death. The adolescent age group (12–18 years were most commonly affected, with a significant male preponderance. Many of the cases were accidental in nature with road traffic accident being the cause. There was much coexistence of the parameters typical of both industrialization and population explosion in developing countries, indicating the epidemiological transition. It is important to find out the origin and causes of childhood deaths to guide health policies in preventing the unnatural deaths. Besides, different legal approaches are also needed for different causes. 

  2. Fatal firearm injuries in autopsy cases at central Bangkok, Thailand: a 10-year retrospective study.

    Science.gov (United States)

    Myint, Sithu; Rerkamnuaychoke, Budsaba; Peonim, Vichan; Riengrojpitak, Suda; Worasuwannarak, Wisarn

    2014-11-01

    Even though there have been previously published reports on firearm injuries in various countries, the incidence and pattern of death from firearm injuries in Thailand have not been studied before. In present study, 149 fatal firearm injuries from 2002 to 2011 were reviewed. At total of 7126 autopsies, fatal firearm injuries comprised of 2.09% (n = 149) of total autopsies cases. Among those victims, 136 were male (91.3%), 13 (8.7%) were female. The youngest age of victim was 10 years and the oldest was 79 years. Mean age of the victims was 33.79 years and median age was 30 years. Outdoor incident was the most common scene of crime. Night time incident (18:00 PM-05:59 AM) was higher than day time one. Most of the cases occurred in week ends (n = 52). Homicide (77.2%) was the most frequent manner of death. Head/face and chest were the most common sites of entrance. The autopsy report also study on entrance wound, range and types of projectiles. Blood alcohol concentration was examined in 122 cases and 38 victims showed positive results, 11 cases revealed using of illegal substances in blood and urine analysis. This study also included the association between manner of death and other factors. Age group, time of incidence, place of incidence, number of entrance wound and range showed statistically significant association with manner of death. PMID:25440139

  3. A comparison of the needle biopsy post mortem with the conventional autopsy.

    Science.gov (United States)

    Foroudi, F; Cheung, K; Duflou, J

    1995-01-01

    Tru-cut biopsy post mortems were compared with the standard full autopsy at a large city mortuary. Subjects consisted of coronial cases excluding suspicious deaths, obvious trauma cases and children under the age of 14 yrs. The following comparisons were made: the ability to collect tissue from each of the organs; any abnormalities detected on histology; correlation of the Tru-cut biopsy results with the results of the conventional post mortem; and determination of cause of death with both techniques. Twenty-one cases were examined by both techniques. Tissue collection by biopsy varied from 100% for liver to 9.5% for kidney with heart, lung and brain giving intermediate results. The cause of death was determined in 9 cases (43%) by biopsy and in 20 cases (95%) by conventional post mortem; the cause of death was not ascertainable in 1 case. In 8 of the 9 cases (89%) where death could be determined by biopsy the cause of death was consistent with the findings of the full autopsy. The cause of death at needle biopsy examination was incorrect in 1 case (11%) compared to the findings of the standard post mortem. Clearly the needle post mortem is inferior to the conventional autopsy in determining the cause of death. PMID:7603760

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

    Directory of Open Access Journals (Sweden)

    María Virginia Bürgesser

    2011-04-01

    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.

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

    Scientific Electronic Library Online (English)

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

    2011-04-01

    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. 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 C [...] órdoba, 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.

  6. Social autopsy for maternal and child deaths: a comprehensive literature review to examine the concept and the development of the method

    OpenAIRE

    Koffi Alain K; Babille Marzio; Salgado Rene; Kalter Henry D; Black Robert E

    2011-01-01

    Abstract "Social autopsy" refers to an interview process aimed at identifying social, behavioral, and health systems contributors to maternal and child deaths. It is often combined with a verbal autopsy interview to establish the biological cause of death. Two complementary purposes of social autopsy include providing population-level data to health care programmers and policymakers to utilize in developing more effective strategies for delivering maternal and child health care technologies, ...

  7. 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)

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

    2009-06-01

    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. M [...] ETODOLOGIA: 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. 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 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.

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

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    Ohno Summer

    2011-08-01

    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.

  9. 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.)

  10. Cause of death among Ghanaian adolescents in Accra using autopsy data

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    Tettey Yao

    2011-09-01

    Full Text Available Abstract Background There is limited data on adolescent mortality particularly from developing countries with unreliable death registration systems. This calls for the use of other sources of data to ascertain cause of adolescent mortality. The objective of this study was to describe the causes of death among Ghanaian adolescents 10 to 19 years in Accra, Ghana utilizing data from autopsies conducted in Korle Bu Teaching Hospital (KBTH. Findings Out of the 14,034 autopsies carried out from 2001 to 2003 in KBTH, 7% were among adolescents. Of the 882 deaths among adolescents analyzed, 402 (45.6% were females. There were 365 (41.4% deaths from communicable disease, pregnancy related conditions and nutritional disorders. Non-communicable diseases accounted for 362 (41% cases and the rest were attributable to injuries and external causes of morbidity and mortality. Intestinal infectious diseases and lower respiratory tract infections were the most common communicable causes of death collectively accounting for 20.5% of total deaths. Death from blood diseases was the largest (8.5% among the non-communicable conditions followed by neoplasms (7%. Males were more susceptible to injuries than females (?2 = 13.45, p = .000. At least five out of ten specific causes of death were as a result of infections with pneumonia and typhoid being the most common. Sickle cell disease was among the top three specific causes of death. Among the females, 27 deaths (6.7% were pregnancy related with most of them being as a result of abortion. Conclusions The autopsy data from the Korle-Bu Teaching Hospital can serve as a useful source of information on adolescent mortality. Both communicable and non-communicable diseases accounted for most deaths highlighting the need for health care providers to avoid complacency in their management of adolescents presenting with these diseases.

  11. Postmortem heart weight modelled using piecewise linear regression in 27,645 medicolegal autopsy cases.

    Science.gov (United States)

    Wingren, Carl Johan; Ottosson, Anders

    2015-07-01

    The interpretation of postmortem heart weight is often difficult, and references for normal heart weight are important. However, to assess the cause of death at a medicolegal autopsy it is also important to have references based on an unselected population of medicolegal autopsy cases with non-natural causes of death (not due directly to disease). We aimed at studying and deriving references for adult heart weight by considering sex, age and body size in cases with an external cause of death. We identified all medicolegal autopsies in Sweden from 1999 to 2013 (n=79,778) and included 27,645 cases. We applied multivariate piecewise linear regression models in three strata of body mass-underweight, normal-/overweight and obesity. We observed that approximately 50% of the variation in heart weight was explained by age, sex and body size. These variables were slightly less important in explaining the variation in heart weight in the underweight and obese compared to in those normal or overweight. Based on the linear regression models we present equations to calculate the predicted heart weight with reference intervals using age, sex, body weight and height. We provide an online heart weight calculator (http://lundforensicmedicine.com) based on these equations. In the forensic interpretation of postmortem heart weights, we suggest that heart weight references derived in cases with an external cause of death is an important complement to references solely based on healthy and normal hearts. Furthermore, the heart weight references presented are derived from a large population, with sufficient numbers for separate models in underweight, normal-/overweight and obese populations. PMID:26004078

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

    Directory of Open Access Journals (Sweden)

    Eduardo Chachamovich

    2013-03-01

    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.

  13. Efficacy of drug screening in forensic autopsy: Retrospective investigation of routine toxicological findings.

    Science.gov (United States)

    Tominaga, Mariko; Michiue, Tomomi; Inamori-Kawamoto, Osamu; Hishmat, Asmaa Mohammed; Oritani, Shigeki; Takama, Masashi; Ishikawa, Takaki; Maeda, Hitoshi

    2015-05-01

    Toxicological analysis is indispensable in forensic autopsy laboratories, but often depends on the limitations of individual institutions. The present study reviewed routine drug screening data of forensic autopsy cases (n=2996) during an 18.5-year period (January 1996-June 2014) at our institute to examine the efficacy of the procedures and findings in autopsy diagnosis and interpretation. Drug screening was performed using on-site immunoassay screening devices and gas chromatography/mass spectrometry (GC/MS) in all cases, followed by re-examination using GC/MS and liquid chromatography/tandem mass spectrometry (LC/MS/MS) at a cooperating institute in specific cases in the last 4years. GC/MS detected drugs in 486 cases (16.2%), including amphetamines (n=160), major tranquilizers (n=72), minor tranquilizers (n=294), antidepressants (n=21), cold remedies (n=77), and other drugs (n=19). Among these cases, fatal intoxication (n=123) involved amphetamines (n=73), major tranquilizers (n=37), minor tranquilizers (n=86), antidepressants (n=3), and cold remedies (n=9); most cases involved self-administration, alleged suicide and accidental overdose, while homicide was not included. These drugs were also identified in other manners of death, including homicide (n=40/372), suicide (n=34/226), accidental falls (n=27/129), and natural death (n=72/514). In these cases, on-site immunoassay screening of drugs of abuse showed negative findings in 2440 cases (81.4% in all cases), while GC/MS detected other drugs in 218 cases (7.3% in all cases), including several antipsychotic drugs, acetaminophen and salicylic acid. Further analysis using LC/MS/MS detected low concentrations of benzodiazepines in 32 cases, and also anti-diabetic and hypertensive drugs in a case of fatal abuse. These observations indicate the efficacy of systematic routine toxicological analysis to investigate not only the cause of death but also the background of fatalities in forensic autopsy. The provision of extensive drug screening is needed for forensic and social risk management, considering the marked diversity of medical and illicit drugs. PMID:25637163

  14. La autopsia en casos de mala praxis Autopsy in medical malpractice

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    F.A. Verdú Pascual

    2002-01-01

    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.

  15. Detection of pathological zinc accumulation in neurons: methods for autopsy, biopsy, and cultured tissue

    DEFF Research Database (Denmark)

    Suh, S W; Listiack, K

    1999-01-01

    It has been repeatedly shown that synaptically released zinc contributes to excitotoxic neuronal injury in ischemia, epilepsy, and mechanical head trauma. Such zinc-induced injury leaves an unmistakable "footprint" in the injured neurons, allowing an easy and unambiguous postmortem diagnosis. This footprint is the presence of weakly bound, histochemically reactive zinc in the cytoplasm of the perikaryon and proximal dendrites. Such staining appears to be a necessary and sufficient marker for zinc-induced neuronal injury. Here we show how to prepare and stain tissue from biopsy, autopsy, or experimental animal sources for maximal contrast and visibility of zinc-injured neurons.

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

    Directory of Open Access Journals (Sweden)

    James Spencer L

    2011-08-01

    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.

  17. Memories of an Autopsy: The Effects of Stress Exposure on Suggestibility for a Stressful Event

    Directory of Open Access Journals (Sweden)

    Elisa Krackow

    2013-02-01

    Full Text Available The current study examined the effects of stressful life events on memory for a stressful event. Two groups ofcollege students (N = 61 were formed for analysis based on the presence or absence of particular stressful lifeevents. Participants then viewed a graphic video depicting an autopsy, and received a memory interview fourdays later. Results showed similar group performance on correctly leading questions. However, participants inthe Specific Stressor-Exposed group were less suggestible to misleading questions than their SpecificStressor-Absent counterparts. Results are discussed in terms of stress sensitization theory and cognitiveprocessing models.

  18. A Moessbauer-effect study of autopsied lung tissue of asbestos workers

    International Nuclear Information System (INIS)

    A 57Fe Moessbauer-effect study of autopsied lung tissue from Canadian asbestos mine workers is presented. The spectra typically show large quantities of iron storage protein. This exhibits a quadrupole-split doublet at room temperature and both a doublet and a Zeeman-split sextet at 4.2 K, due to a distribution of particle sizes. A comparison is made with Moessbauer spectra of lung tissue from an individual not occupationally exposed to respirable asbestos, and with spectra of respirable chrysotile asbestos taken from Canadian mines. (author)

  19. Fatal tolperisone poisoning: autopsy and toxicology findings in three suicide cases.

    Science.gov (United States)

    Sporkert, Frank; Brunel, Christophe; Augsburger, Marc P; Mangin, Patrice

    2012-02-10

    Tolperisone (Mydocalm) is a centrally acting muscle relaxant with few sedative side effects that is used for the treatment of chronic pain conditions. We describe three cases of suicidal tolperisone poisoning in three healthy young subjects in the years 2006, 2008 and 2009. In all cases, macroscopic and microscopic autopsy findings did not reveal the cause of death. Systematic toxicological analysis (STA) including immunological tests, screening for volatile substances and blood, urine and gastric content screening by GC-MS and HPLC-DAD demonstrated the presence of tolperisone in all cases. In addition to tolperisone, only the analgesics paracetamol (acetaminophen), ibuprofen and naproxen could be detected. The blood ethanol concentrations were all lower than 0.10 g/kg. Tolperisone was extracted by liquid-liquid extraction using n-chlorobutane as the extraction solvent. The quantification was performed by GC-NPD analysis of blood, urine and gastric content. Tolperisone concentrations of 7.0 mg/l, 14 mg/l and 19 mg/l were found in the blood of the deceased. In the absence of other autopsy findings, the deaths in these three cases were finally explained as a result of lethal tolperisone ingestion. To the best of our knowledge, these three cases are the first reported cases of suicidal tolperisone poisonings. PMID:21683537

  20. Atherosclerosis of Coronary Arteries as Predisposing Factor in Myocardial Infarction: An Autopsy Study

    Directory of Open Access Journals (Sweden)

    Gauravi A Dhruva,

    2012-10-01

    Full Text Available The incidence of coronary heart disease has markedly increased in India over the past few years. Ischemic heart disease, the largest cause of morbidity and mortality in the developed and developing countries today is overwhelmingly contributed by atherosclerosis. The study highlights the impact of atherosclerotic lesions in the population of Rajkot district. We studied atherosclerotic lesions in coronary arteries in cases subjected to autopsy in last 4 years, to grade and to evaluate the atheromatous plaques; and to assess the cases of myocardial infarction amongst them. The study comprises dissected specimens of heart in total 360 cases subjected for autopsy. The vessels were examined for the presence of atherosclerotic lesions which were graded according to American Heart Association and examined for evidence of myocardial infarction. The study comprises the cases in age group between 20 to 80 years. Commonest type of atherosclerosis seen was grade-4. Left Anterior Descending Coronary was most commonly involved artery. Myocardial infarction was the cause of death in 35 cases (9.72% The data obtained may form a baseline for the forthcoming studies.

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

    Scientific Electronic Library Online (English)

    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.

    2013-05-01

    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 st [...] udy. 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.

  2. Small-cell neuroendocrine carcinoma of the esophagus: an autopsy case report

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    Mariana Bellaguarda de Castro Sepulvida

    2014-03-01

    Full Text Available Small-cell neuroendocrine carcinoma is a well-known aggressive neoplasia, which is usually associated with a poor prognosis. The lung is the most common primary site, but other organs may be involved, especially those of the digestive tract. The authors report the case of a 71-year-old Caucasian, male patient who was admitted because of congestive heart failure and loss of vision accompanied by right proptosis. Skull and sinuses computed tomography showed a tumoral mass involving the posterior region of the right eye, local bones, and paranasal sinuses. Because of severe hemodynamic instability, the patient died and no diagnostic investigation could be performed. Autopsy findings revealed small-cell neuroendocrine carcinoma of the esophagus and metastases to the posterior region of the right ocular globe, which affected the sinuses, the muscles of the ocular region, the orbit bones, the skull, the meninges and the brain, plus the liver, adrenal glands, and the pericardium. This case called the author’s attention to the extent of the metastatic disease in a patient who was firstly interpreted as presenting solely with congestive heart failure. The autopsy findings substantially aid the understanding of the immediate cause of death.

  3. Histopathologic findings in autopsy cases after radiotherapy for cancer pain from bone marrow metastasis

    International Nuclear Information System (INIS)

    The purpose of this was to study the mechanisms of cancer pain and effects of irradiation in metastatic bone marrow patients, histopathologically. Sixteen autopsy cases including 9 breast tumors, 4 hepatic cell carcinomas, 2 gastric cancers and 1 triple cancer of the renal pelvis, urinary bladder and liver were studied. Symptomatically, the effects of radiotherapy (36?56 Gy) for cancer pain were freedom from pain in 4 (25%), pain relief in 8 (50%), no effect in 3 (18.8%) and undetectable in 1. The sites of irradiation were thoracic in 7, lumbar in 5, thoracolumbar in 3, and cervicothoracic vertebra in 1. At autopsy, no cancer cells were found at the site of irradiation in 5 subjects. The histopathologic appearance of painful metastases to bones was periosteal infiltration in 8, perineural invasion in 3, nervous compression in 4 and compression fracture or collapse in 8. The reaction of metastatic bone marrow to irradiation showed mixed type in 8, intertrabecullar types in 4, osteolytic type in 1, and osteoplastic type in 2. Cancer pain was associated with several histopathologic findings, and the histopathological effects of radiation for such pain were weak. Further histopathologic study of the mechanisms of cancer pain and effects of irradiation may be necessary for better quality of life (QOL) for patients. (author)

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

    Scientific Electronic Library Online (English)

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

    2004-05-01

    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.

  5. Impact of diabetes mellitus on myocardial lipid deposition: an autopsy study.

    Science.gov (United States)

    Nakanishi, Takaya; Kato, Seiya

    2014-12-01

    Lipid accumulation in the cardiac parenchyma has historically been known as fatty heart. Myocardial lipotoxicity and cardiac steatosis have been shown to be involved in the pathogenesis of obesity and diabetic mellitus (DM). Mutated adipose triglyceride lipase (ATGL), a key catalytic enzyme of triglyceride, has been found to cause human triglyceride deposit cardiomyovasculopathy (TGCV). Nevertheless, the significance of fatty heart in the disease process is still unclear. Here, we investigated myocardial lipid deposition (LD) in 73 autopsy cases. Nile blue staining revealed seven cases (9.5%) showing LD with elevated tissue triglyceride content, all of which suffered from DM. Immunohistochemically, ATGL expression was preserved in all tested cases. Rates of myocardial infarction and heart failure were higher in LD/DM cases than in non-LD cases. Semi-quantitative histological analysis revealed no significant differences in the degree of myocardial hypertrophy, myofibrillar loss, fibrosis, small vascular disease, inflammation or fat invasion between LD/DM and non-LD cases. However, more severe histological damage was seen in DM cases than in non-DM cases. Our data suggest that DM is a major risk for fatty heart with myocardial LD based on recent autopsy cases. PMID:24836730

  6. An optimized protocol for the acute isolation of human microglia from autopsy brain samples.

    Science.gov (United States)

    Olah, Marta; Raj, Divya; Brouwer, Nieske; De Haas, Alexander H; Eggen, Bart J L; Den Dunnen, Wilfred F A; Biber, Knut P H; Boddeke, Hendrikus W G M

    2012-01-01

    Microglia are increasingly recognized to be crucially involved in the maintenance of tissue homeostasis of the brain and spinal cord. Not surprisingly is therefore the growing scientific interest in the microglia phenotypes associated with various physiological and pathological processes of the central nervous system. Until recently the investigation of these phenotypes was hindered by the lack of an isolation protocol that (without an extended culturing period) would offer a microglia population of high purity and yield. Thus, our objective was to establish a rapid and efficient method for the isolation of human microglia from postmortem brain samples. We tested multiple elements of already existing protocols (e.g., density separation, immunomagnetic bead separation) and combined them to minimize preparation time and maximize yield and purity. The procedure presented in this article enables acute isolation of human microglia from autopsy (and biopsy) samples with a purity and yield that is suitable for downstream applications, such as protein and gene expression analysis and functional assays. Moreover, the present protocol is appropriate for the isolation of microglia from autopsy samples irrespective of the neurological state of the brain or specific brain regions and (with minor modification) could be even used for the isolation of microglia from human glioma tissue. PMID:21989594

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

    Directory of Open Access Journals (Sweden)

    Dgedge Martinho

    2001-01-01

    Full Text Available 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.

  8. Autopsy findings of a patient with rapidly progressive massive ascites caused by alcoholic cirrhosis.

    Science.gov (United States)

    Noritake, Kanako; Unuma, Kana; Nara, Akina; Uchida, Kyoko; Shiratori, Tsukasa; Watanuki, Yumi; Funakoshi, Takeshi; Uemura, Koichi

    2011-05-01

    A 54-year-old man, who lived alone, was hospitalized due to rapid deterioration of the general condition over a three-week period caused by alcoholic cirrhosis. One month after he left hospital, he was found dead in his house by his friend. Three days before he was found dead, he had met his friend and seemed to be in poor condition. Autopsy was conducted by a medical examiner to clarify the cause of death. Externally, signs of severe jaundice were apparent over the whole body, along with extensive abdominal swelling and edema of the extremities. Autopsy findings demonstrated that the abdominal cavity contained an amount of massive turbid and slight pale reddish brown ascites (23 l). There were no findings of severe peritoneal inflammation. The liver (650 g) was elastic hard and had a micro-nodular surface, which showed severe atrophy. Microscopic examination of the liver showed clear pseudolobule with severe fibrosis in the stroma. There were no significant changes in the heart or brain. The stomach was empty and only a slight amount of intestinal contents. There was no ethanol detected in the blood or urine. The direct cause of his death was circulatory dysfunction due to massive accumulation of the ascites. The reasons for the massive ascites accumulation over 20 l in this case were (1) that he had no serious complications other than ascites; and (2) he did not have any medical treatment just before his death. PMID:21277247

  9. Cardiovascular Damage in Alzheimer Disease: Autopsy Findings From the Bryan ADRC

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    Corder Elizabeth H.

    2005-01-01

    Full Text Available Autopsy information on cardiovascular damage was investigated for pathologically confirmed Alzheimer disease (AD patients (n = 84 and non-AD control patients (n = 60 . The 51 relevant items were entered into a grade-of-membership model to describe vascular damage in AD. Five latent groups were identified “I: early-onset AD,” “II: controls, cancer,” “III: controls, extensive atherosclerosis,” “IV: late-onset AD, male,” and “V: late-onset AD, female.” Expectedly, Groups IV and V had elevated APOE ϵ 4 frequency. Unexpectedly, there was limited atherosclerosis and frequent myocardial valve and ventricular damage. The findings do not indicate a strong relationship between atherosclerosis and AD, although both are associated with the APOE ϵ 4 . Instead, autopsy findings of extensive atherosclerosis were associated with possible, not probable or definite AD, and premature death. They are consistent with the hypothesis that brain hypoperfusion contributes to dementia, possibly to AD pathogenesis, and raise the possibility that the APOE allele ϵ 4 contributes directly to heart valve and myocardial damage.

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

    Scientific Electronic Library Online (English)

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

    2013-03-01

    Full Text Available 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 evaluación 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 analyze [...] d 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; 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.

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

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    Ygnacio Ygualada Correa

    2013-03-01

    Full Text Available 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 evaluación 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.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; 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.

  12. Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol

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    Thayyil Sudhin

    2011-12-01

    Full Text Available Abstract Background Minimally invasive autopsy by post mortem magnetic resonance (MR imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death. Methods/Design We recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging, blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person. Discussion Using conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system. Clinical Trial Registration NCT01417962 NIHR Portfolio Number: 6794

  13. Mortality patterns in Vietnam, 2006: Findings from a national verbal autopsy survey

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    Adair Timothy

    2010-03-01

    Full Text Available Abstract Background Accurate nationally representative statistics on total and cause-specific mortality in Vietnam are lacking due to incomplete capture in government reporting systems. This paper presents total and cause-specific mortality results from a national verbal autopsy survey conducted first time in Vietnam in conjunction with the annual population change survey and discusses methodological and logistical challenges associated with the implementation of a nation-wide assessment of mortality based on surveys. Verbal autopsy interviews, using the WHO standard questionnaire, were conducted with close relatives of the 6798 deaths identified in the 2007 population change survey in Vietnam. Data collectors were health staff recruited from the commune health station who undertook 3-day intensive training on VA interview. The Preston-Coale method assessed the level of completeness of mortality reporting from the population change survey. The number of deaths in each age-sex grouping is inflated according to the estimate of completeness to produce an adjusted number of deaths. Underlying causes of death were aggregated to the International Classification of Diseases Mortality Tabulation List 1. Leading causes of death were tabulated by sex for three broad age groups: 0-14 years; 15-59 years; and 60 years and above. Findings Completeness of mortality reporting was 69% for males and 54% for females with substantial regional variation. The use of VA has resulted in 10% of deaths being classified to ill-defined among males, and 15% among females. More ill-defined deaths were reported among the 60 year or above age group. Incomplete death reporting, wide geographical dispersal of deaths, extensive travel between households, and substantial variation in local responses to VA interviews challenged the implementation of a national mortality and cause of death assessment based on surveys. Conclusions Verbal autopsy can be a viable tool to identify cause of death in Vietnam. However logistical challenges limit its use in conjunction with the national sample survey. Sentinel population clusters for mortality surveillance should be tested to develop an effective and sustainable option for routine mortality and cause of death data collection in Vietnam.

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

    LENUS (Irish Health Repository)

    2012-01-31

    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.

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

    Science.gov (United States)

    Briese, Juliane; Noack, Frank; Harland, Albrecht; Horny, Hans-Peter

    2006-01-01

    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. PMID:16424671

  16. 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 feasibilityion: 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.

  17. Complications in autopsy cases of Hashimoto's disease with special reference to A-bomb exposure

    International Nuclear Information System (INIS)

    To clarify a relationship between A-bomb exposure and Hashimoto's disease and that between Hashimoto's disease and carcinoma of the thyroid gland, autopsy cases of Hashimoto's disease (112 cases in Hiroshima and 43 cases in Nagasaki) were examined. Incidence of Hashimoto's disease was not related to exposure doses and ages at the time of exposure. Incidence of carcinoma of the thyroid gland from Hashimoto's disease was 1.3% (2 cases), and there was no relationship between them. Incidence of ovarian cancer as cancer accompanied with Hashimoto's disease was significantly high, but that of stomach cancer was significantly low. Incidence of total cancer from Hashimoto's disease was also significantly low. Incidences of rheumatic fever and rheumatoid arthritis which were collagen diseases and diseases similar to them complicated by Hashimoto's disease was significantly high. (Tsunoda, M.)

  18. [Arrhythmogenic right ventricular cardiomyopathy versus fatty replacement of the right ventricle. An autopsy case report].

    Science.gov (United States)

    Hourseau, Muriel; Fornès, Paul; Lagorce, Christine; Lefrancq, Thierry; Martin, Antoine

    2002-12-01

    We report an autopsy case of a cardiomyopathy characterized by fatty replacement of the right ventricular myocardium and compare its clinical and histologic characteristics with those of the arrhythmogenic right ventricular cardiomyopathy. A 39-year old male died suddenly in a hospital room. He had an alcoholic cirrhosis with ascitis, but the clinical examination and the biology showed no abnormalities explaining the death. Histologically, in the right ventricle, large areas of cardiomyocytes were replaced by fat, but there was no fibrosis. In contrast, fibrosis is present in association with fat in arrhythmogenic right ventricular cardiomyopathy. Fatty replacement of the right ventricle is likely to be a distinct entity. Right ventricular failure has been shown to be a possible complication. Sudden death is probably rare and is likely to occur when other arrhythmogenic factors are associated. PMID:12594390

  19. An autopsy case of peritoneal malignant mesothelioma in a radiation technologist

    International Nuclear Information System (INIS)

    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)

  20. An autopsy case of peritoneal malignant mesothelioma in a radiation technologist

    Energy Technology Data Exchange (ETDEWEB)

    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

    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).

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

    Science.gov (United States)

    Harada, Kazuki; Kuroda, Ryohei; Nakajima, Makoto; Takizawa, Ayako; Yoshida, Ken-ichi

    2012-09-01

    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. PMID:22633563

  2. An autopsy case of spinal arteriovenous malformation (Foix-Alajouanine syndrome.

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    Kuroda,Shigetoshi

    1991-12-01

    Full Text Available An autopsy case of spinal arteriovenous malformation (AVM was reported. The patient was a 75-year-old male and his initial neurologic symptoms were paraplegia, paresthesia below the umbilical level and urination difficulty. Subsequently night delirium and parkinsonism also appeared. The clinical and pathological findings in this case are identical with those in the spinal AVM except for Parkinson's disease. In addition, the lateral funiculus of the spinal cord in the middle thoracic segment showed pallor: Under light microscopy, the funiculus was spongiform, with a thinner wall of the myelin sheath, enlargement of the axon and the perivascular infiltration of phagocytes without plasma exudation. The changes in the lateral funiculus seemed to indicate early congestive changes.

  3. Harlequin ichthyosis: A medico legal case report & review of literature with peculiar findings in autopsy.

    Science.gov (United States)

    Jilumudi, Uday Bhaskar Reddy

    2012-08-01

    Ichthyosis fetalis or Harlequin ichthyosis is an extremely severe and fatal hereditary skin disorder with an autosomal recessive inheritance. It is distinctive because of its remarkable clinical appearance which includes epidermal keratinization, hypoplasia of fingers or nails, malformation of ear and nose and incompatibility with life. This report describes a case of Harlequin ichthyosis along with detailed autopsy findings, which manifested the suspended animation in the early hours after delivery and showing a peculiar malformation of the cerebral hemispheres. To the best of the knowledge, this may be the first report of Harlequin ichthyosis in the forensic literature describing mal development of cerebral hemispheres and suspended animation in a case of Harlequin Ichthyosis. PMID:22847055

  4. Glomerulocystic Kidney Disease and its rare associations: an autopsy report of two unrelated cases

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    Sachdeva Man

    2007-04-01

    Full Text Available Abstract Background Glomerulocystic kidney disease is an uncommon type of cystic renal disease. It is characterized by cortical microsysts, which are represented by cystic dilatation of Bowman's spaces. Case presentation We describe a case of glomerulocystic disease in a neonate and another in an abortus associated with tracheo-oesophageal fistula and megacystic-megaureter syndrome. The kidney on autopsy was sponge-like and revealed presence of cysts corresponding to dilatations of Bowman's space microscopically. In these two cases, the Glomerulocystic Kidney Disease in one case corresponded to a sporadic form and, in the other, to a syndromic, non-heritable form of glomerulocystic kidney disease. Conclusion The associated anomalies in Glomerulocystic Kidney disease are well described in the literature. Two more new unrelated associations are described in this article.

  5. A logistic regression model for estimating transport accident deaths using verbal autopsy data.

    Science.gov (United States)

    Klinjun, Nuntaporn; Lim, Apiradee; Bundhamcharoen, Kanitta

    2015-04-01

    This study aimed to create an appropriate model using verbal autopsy (VA) data to estimate transport accident deaths from vital registration data in Thailand. A sample of 9644 VA deaths was obtained from the Thai Ministry of Public Health. VA assessed transport accidents accounted for 546 deaths (5.7% of sample). Logistic regression was used to model transport accident deaths classified by 9 provinces, 16 gender-age groups, 14 combinations of vital reported cause groups, and place of death (in or outside hospital). The receiver operating characteristic curve was used to match the number of reported transport accident deaths to the number predicted by the model with sensitivity 73.8% and false positive rate 1.6%. The estimated transport accident deaths ranged from 1.68 to 2.65 times higher than the vital registration data reported according to gender-age groups. PMID:24733281

  6. Cervical soft tissue emphysema in hanging--a prospective autopsy study.

    Science.gov (United States)

    Nikoli?, Slobodan; Zivkovi?, Vladimir; Babi?, Dragan; Jukovi?, Fehim

    2012-01-01

    The underlying mechanism of cervical soft tissue emphysema (CSTE) in hanging remains unclear. The aim of this study was to determine the frequency of CSTE in cases of hanging. The sample included 83 deceased persons, average age 55.3 ± 17.9 years. CSTE was established in 44 cases. CSTE is presented as frothy air, soap bubble-like formations in superficial and/or deep connective tissue between the neck muscles up to the ligature mark, visible during gross neck examination, using special neck autopsy technique-preparation of the neck organs in layers. The interpretation of positive CSTE must be taken with caution: it could be an antemortem phenomenon possibly because of either Macklin Effect or direct or indirect trauma to the cervical airways, as well as an ante- or postmortem artifact. PMID:21923797

  7. Wilson's disease: A Clinical autopsy case report with review of literature.

    Science.gov (United States)

    Raju, Kalyani; Bangalore, Gayathri Nagaraj; Thuruvekere, Suresh Nagaraj; Pathavanalli, Venkatarathnamma Narayanappa

    2015-01-01

    Wilson's disease is an autosomal recessive disease resulting in defective copper metabolism, which is usually seen in young adults, predominantly affecting liver and brain. Although it is not uncommon in India, variation in epidemiology, clinical presentation and course are reported. However, community-based incidence and prevalence rates are not available in India and incidences are limited to hospital based reports. Most often, the diagnosis is delayed. We present a clinical autopsy case in a 39 year-old female who had presented with clinical symptoms at 18 years of age. The duration of illness was 21 years. Patient's parent had consanguineous marriage and the younger sibling had died at 5 years of age with similar complaints. PMID:25810676

  8. Ventriculocoronary connections in hypoplastic right heart syndrome: autopsy serial section study of six cases.

    Science.gov (United States)

    O'Connor, W N; Stahr, B J; Cottrill, C M; Todd, E P; Noonan, J A

    1988-05-01

    Myocardial sinusoids communicating with the coronary systems occur in pulmonary atresia with intact ventricular septum. To test the hypothesis that the extent of ventriculocoronary connections correlates with the degree of right ventricular outflow obstruction as evidenced by clinical, angiographic and gross anatomic findings, a serial section study of six human autopsy hearts representing a spectrum of hypoplastic right heart was undertaken. Slides were evaluated for the presence and extent of ventriculocoronary connections, associated developmental abnormalities and secondary changes in the ventricular walls. Whereas extensive blind-ended deep sinusoids were a feature of all five cases with unrelieved obstruction, ventriculocoronary connections were identified in three. Changes that suggested ongoing remodeling provide new evidence for the postnatal temporal evolution of these anomalous communications. The regional distribution of myofiber disarray in hypoplastic right heart supports the concept that vascularization parallels myocardial organization in the developing human heart. PMID:3281992

  9. Autopsy report on pseudo-Bartter syndrome with renal calcification induced by diuretics and diet pills.

    Science.gov (United States)

    Unuma, Kana; Tojo, Akihiro; Harada, Kazuki; Saka, Kanju; Nakajima, Makoto; Ishii, Takeshi; Fujita, Toshiro; Yoshida, Ken-Ichi

    2009-01-01

    A woman in her mid-forties had repeated vomiting and diarrhoea accompanied by muscle weakness soon after she started taking seven different diet pills imported from Thailand. After she had taken the pills for 8 days, respiratory depression progressed rapidly to arrest. Blood tests at the Emergency Department showed severe hypokalaemia with metabolic alkalosis. We diagnosed that she had developed pseudo-Bartter syndrome from the findings based on ionic abnormalities and high renin and aldosterone levels, and hyperplasia of the juxtaglomerular apparatus. A postmortem blood analysis indicated subtherapeutic levels of furosemide. We concluded that the patient died from pseudo-Bartter syndrome, which was triggered by chronic self-administration of furosemide and aggravated by the diet pills. This is the first pseudo-Bartter syndrome autopsy report to show histological localisation of calcification in the kidneys. PMID:21686346

  10. The Frequencies of the Urinary Anomalies which were Detected in a Foetal Autopsy Study

    Science.gov (United States)

    Gupta, Tulika; Kapoor, Kanchan; Sharma, A.; Huria, A.

    2012-01-01

    Aim The detection of foetal urinary abnormalities in the antenatal period will help in an adequate post natal management and it will also have a bearing on the decision of the termination of the pregnancy. The purpose of the present study was to detect urinary anomalies in the antenatal period by doing autopsies of the aborted foetuses. Settings and Design A cross-sectional study. Methods and Material A total of 226 aborted foetuses were autopsied. The urinary anomalies which were related to the renal parenchyma, the pelvi-ureteral system and the urinary bladder were recorded. The associated anomalies of the other organ systems were also noted. The incidences of the different urinary anomalies among the aborted foetuses were calculated. The gestational ages at which the various anomalies were detected were also studied. Results Twenty nine of the 226 fetuses were detected to have 34 urinary anomalies. Renal agenesis was the single most common anomaly. Overall, the anomalies which were related to the renal parenchyma accounted for 67.65 % of all the urinary anomalies, while the anomalies of the pelvi-ureteral system and the bladder constituted 20.59% of the detected urinary anomalies. The anomalies of the renal parenchyma (renal agenesis and horse-shoe and polycystic kidneys) were more frequently seen in the foetuses with a shorter gestational age as compared to the gestational ages of the foetuses which showed pelvi-ureteral anomalies. The cumulative incidence of the foetuses with urinary anomalies by 30 weeks of gestation was 12.83%. Conclusions A significant proportion of the aborted foetuses was detected to have urinary anomalies. An early antenatal detection of these and associated anomalies has significance, as this may help in an early postnatal diagnosis and management. The degree and the extent of the detected anomalies could also help in the decision making regarding the therapeutic abortions and the future pregnancies. PMID:23373012

  11. The medical malpractice in Milan-Italy. A retrospective survey on 14 years of judicial autopsies.

    Science.gov (United States)

    Casali, Michelangelo Bruno; Mobilia, Francesca; Del Sordo, Sara; Blandino, Alberto; Genovese, Umberto

    2014-09-01

    The medical malpractice is a rising and central topic for the forensic pathologist and forensic autopsies are a mandatory step in the judicial evaluation of the suspected medical malpractice. Reliable national and international registers about the medical malpractice are still missing and nowadays the necroscopic archives are therefore one of the best sources of data about such a complex phenomenon. We analyzed the archive of the Institute of Forensic Medicine of the Milan University from 1996 to 2009 and selected 317 lethal cases of suspected medical malpractice. The mean age of our cases was 60±18 years for males and 58±19 years for the females. In 70% of such cases the patient death occurred in a hospital setting. The first 24h of hospitalization turned out to be the hottest period for deaths followed by malpractice claims. The surgical branches were obviously the most involved, with abdominal surgery, orthopedics, neurosurgery and gynecology as the main contributors. Just 12% of the total amount of cases came from all the internistic branches put together. Non-hospital malpractice was typically caused by misdiagnosed myocardial infarctions and aortic ruptures. A full forensic report was present in 71 cases (all belonging to the 2007-2009 period): in 69% of cases the judicial autopsy revealed as a sufficient tool for diagnosing the cause of death; medical malpractice was confirmed in only 17% of the whole cases and a causal link between the ascertained malpractice and the patient death was recognized in only 12.7% cases. PMID:25023215

  12. Pattern of homicide coroner's autopsies at University College Hospital, Ibadan, Nigeria: 1997-2006.

    Science.gov (United States)

    Eze, U O; Akang, E E U; Odesanmi, W O

    2011-01-01

    There is relatively little information regarding the pattern of homicides in developing countries such as Nigeria. This study is aimed at determining the pattern and demographic factors associated with homicide cases seen in a Nigerian Teaching Hospital. It is a descriptive autopsy study of homicide cases seen at the University College Hospital (UCH), Ibadan over a 10-year period from January 1997 to December 2006. All the coroner's autopsies for the period, of homicides or suspected homicides, were reviewed with emphasis on the following: gender, age, occupation, circumstances surrounding event, likely motive, type of weapon used, site(s) of injury and mechanism of death. Homicides accounted for 153 (3.1%) of the 4928 coroner's cases at the UCH within the study period. One hundred and thirty-seven of the 152 cases were men, and the overall age range was 4-83 years. The mechanism of death was haemorrhagic shock in 91 cases (59.9%); severe raised intracranial pressure in 58 cases (38.2%); septicaemic shock in two cases (1.3%); and asphyxia in one case (0.7%). Gunshot injuries accounted for 64.5% of the fatalities, sharp objects 21.1% and blunt force 14.5%. Most were victims of armed robbery attacks. The head, abdomen, chest and lower limbs were single sites of injuries in descending order of frequency and most of the cases sustained multiple injuries involving two or more of these sites. Gunshot deaths were the commonest form of homicides in the period under review. Young males and victims of armed robbery attacks were most susceptible. PMID:21595421

  13. Impact of angiotensin receptor blockers on Alzheimer's disease neuropathology in a large brain autopsy series

    Science.gov (United States)

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

    2013-01-01

    Background Angiotensin II may be involved in amyloid metabolism in the brain. Angiotensin receptor blockers (ARB) may also prevent cognitive decline. We evaluated the impact of ARBs on the neuropathology in the National Alzheimer’s Coordinating Center (NACC) database which includes aggregated data and brain autopsies from 29 Alzheimer’s Disease Centers throughout the USA. Methods Data from Participants were self- or provider-referred and included those with and without cognitive disorders. Our sample included hypertensive participants and excluded cognitively and neuro-pathologically normal participants (n=890, mean (range) age at death 81 (39–107) years, 43% women, 94% white). Neuropathological data included neuritic plaque and neurofibrillary tangle densities assessed by NIA-Reagan criteria and vascular injury markers. Multiple logistic regression was used to compare the pathological findings in subjects on ARBs to other antihypertensive treatment and to those who did not receive antihypertensive medications. Results Participants who were exposed to ARBs, with or without AD, showed less amyloid deposition markers compared to those treated with other antihypertensives (lower CERAD OR=0.47, 95% confidence interval =0.27 to 0.81; ADRDA OR=0.43, CI=0.21 to 0.91; BRAAK & BRAAK OR=0.52, CI= 0.31 to 0.85; neuritic plaques OR=0.59, CI=0.37 to 0.96). They also had less AD-related pathology compared to untreated hypertensives. Participants receiving ARBs were more likely to have had a stroke and hence had more frequent pathological 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

  14. Development of novel software to generate anthropometric norms at perinatal autopsy.

    Science.gov (United States)

    Cain, Matthew D; Siebert, Joseph R; Iriabho, Egiebade; Gruneberg, Alexander; Almeida, Jonas S; Faye-Petersen, Ona Marie

    2015-01-01

    Fetal and infant autopsy yields information regarding cause of death and the risk of recurrence, and it provides closure for parents. A significant number of perinatal evaluations are performed by general practice pathologists or trainees, who often find them time-consuming and/or intimidating. We sought to create a program that would enable pathologists to conduct these examinations with greater ease and to produce reliable, informative reports. We developed software that automatically generates a set of expected anthropometric and organ weight ranges by gestational age (GA)/postnatal age (PA) and a correlative table with the GA/PA that best matches the observed anthropometry. The program highlights measurement and organ weight discrepancies, enabling users to identify abnormalities. Furthermore, a Web page provides options for exporting and saving the data. Pathology residents utilized the program to determine ease of usage and benefits. The average time using conventional methods (ie, reference books and Internet sites) was compared to the average time using our Web page. Average time for novice and experienced residents using conventional methods was 26.7 minutes and 15 minutes, respectively. Using the Web page program, these times were reduced to an average of 3.2 minutes (P < 0.046 and P < 0.02, respectively). Participants found our program simple to use and the corrective features beneficial. This novel application saves time and improves the quality of fetal and infant autopsy reports. The software allows data exportation to reports and data storage for future analysis. Finalization of our software to enable usage by both university and private practice groups is in progress. PMID:25634794

  15. Mobile education in autopsy conferences of pathology: presentation of complex cases

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    Kayser Klaus

    2006-11-01

    Full Text Available Abstract Background MeduMobile was a project to develop and evaluate learning scenarios for medical students and teachers by use of video communication and notebooks. Its core part was assigned to various medical routines, conferences or meetings such as doctor-patient bedside conversation. These were filmed by video teams and broadcasted live via the WLAN of the Charité campus to course participating students. One type of the learning arrangements was the autopsy conference as an on-call scenario. Materials and methods The MeduMobile project consisted of two main compartments: the regular seminar event which took place every week or month, and the on-call event. For an on-call event the students were informed two hours before the lesson's start. A mobile video team organised the video conference via a specific MeduMobile seminar system. This software offered the students to log. The MeduMobile seminar system is based on the Windows operating system and realises an extended video communication via WLAN. Thirteen access points were implemented at the Charité Campus Virchow Klinikum and Campus Mitte. A questionnaire was developed to investigate in the response and learning effect of the mobile seminar system. Results During the MeduMobile project 42 video conferences with (cumulative 145 participating students took place. Four autopsy conferences could be organised as on-call scenarios within this project. A prospective, not randomised follow-up study was included 25 students of the 1st – 6th clinical semester. According to the answers, professional reasoning, professional performance, sustainability, and the complexity were broadly accepted by the students. Discussion In principle, the MeduMobile realised an interdisciplinary case presentation using video conference and web page. The evaluation indicates a high acception of such complex case presentation with multidisciplinary settings. The use of the notebooks in mobile learning enables an interconnective training and promotes a complex learning.

  16. Sudden Cardiac Death in Brazil: A Community-Based Autopsy Series (2006-2010)

    Science.gov (United States)

    Braggion-Santos, Maria Fernanda; Volpe, Gustavo Jardim; Pazin-Filho, Antonio; Maciel, Benedito Carlos; Marin-Neto, José Antonio; Schmidt, André

    2015-01-01

    Background Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause, that occurs in less than one hour after the symptoms onset, in a person without any previous condition that would seem fatal or who was seen without any symptoms 24 hours before found dead. Although it is a relatively frequent event, there are only few reliable data in underdeveloped countries. Objective We aimed to describe the features of SCD in Ribeirão Preto, Brazil (600,000 residents) according to Coroners’ Office autopsy reports. Methods We retrospectively reviewed 4501 autopsy reports between 2006 and 2010, to identify cases of SCD. Specific cause of death as well as demographic information, date, location and time of the event, comorbidities and whether cardiopulmonary resuscitation (CPR) was attempted were collected. Results We identified 899 cases of SCD (20%); the rate was 30/100000 residents per year. The vast majority of cases of SCD involved a coronary artery disease (CAD) (64%) and occurred in men (67%), between the 6th and the 7th decades of life. Most events occurred during the morning in the home setting (53.3%) and CPR was attempted in almost half of victims (49.7%). The most prevalent comorbidity was systemic hypertension (57.3%). Chagas’ disease was present in 49 cases (5.5%). Conclusion The majority of victims of SCD were men, in their sixties and seventies and the main cause of death was CAD. Chagas’ disease, an important public health problem in Latin America, was found in about 5.5% of the cases. PMID:25424162

  17. Plutonium in autopsy tissue: a revision and updating of data reported in LA-4875

    International Nuclear Information System (INIS)

    Human tissues, obtained at autopsy in several geographical locations in the United States exposed primarily to atmospheric fallout from weapons testing and those from individuals who formerly worked with plutonium, have been analyzedquantitatively for plutonium in a continuing study at the Alamos Scientific Laboratory. This article contains additional data accumulated since publication of LASL report LA-4875, 'Plutonium in Autopsy Tissue', in 1973 and includes some reanalyses of the questionable results included in that report. The primary objectives of the present study are to determine the baseline concentrations of plutonium in the general populations and to monitor for changes that may be related to growth of the nuclear industry; obtain data on the long-range time dependence of fallout plutonium incorporation into the body; determine plutonium distribution in the body from various routes of intake; and provide a means for evaluating the validity of in vivo estimates of plutonium body burdens in occupationally exposed workers. The tissues analyzed include lung, tracheobronchial lymph nodes, liver, bone, kidney, and recently, gonads, thyroid, and spleen. The median concentrations observed in the general population (dis/min per kg of tissue wet weight) are; tracheobronchial lymph node (360), 5.8; liver (701), 1.6; vertebrae (325), 0.6; rib (95); thyroid (184), 0.6; lung (705), 0.4; gonad (264), 0.3; spleen (325), 0.2; and kidney (631), 0.1. The parenthetical numbersdney (631), 0.1. The parenthetical numbers indicate the number of samples analyzed. The results of the analyses of tissues from occupationally exposed workers are reported in a subsequent article. (author)

  18. 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)

  19. CMV quantitative PCR in the diagnosis of CMV disease in patients with HIV-infection – a retrospective autopsy based study

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    Goplen Anne K

    2007-11-01

    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.

  20. Situación actual y perspectiva de la autopsia en Cuba / Present situation and prospects of autopsy in Cuba

    Scientific Electronic Library Online (English)

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

    2013-03-01

    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. 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 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.

  1. Effects on the estimated cause-specific mortality fraction of providing physician reviewers with different formats of verbal autopsy data

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    Chow Clara

    2011-08-01

    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.

  2. Stillbirths and newborn deaths in slum settlements in Mumbai, India: a prospective verbal autopsy study

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    Bapat Ujwala

    2012-05-01

    Full Text Available Abstract Background Three million babies are stillborn each year and 3.6 million die in the first month of life. In India, early neonatal deaths make up four-fifths of neonatal deaths and infant mortality three-quarters of under-five mortality. Information is scarce on cause-specific perinatal and neonatal mortality in urban settings in low-income countries. We conducted verbal autopsies for stillbirths and neonatal deaths in Mumbai slum settlements. Our objectives were to classify deaths according to international cause-specific criteria and to identify major causes of delay in seeking and receiving health care for maternal and newborn health problems. Methods Over two years, 2005–2007, births and newborn deaths in 48 slum areas were identified prospectively by local informants. Verbal autopsies were collected by trained field researchers, cause of death was classified by clinicians, and family narratives were analysed to investigate delays on the pathway to mortality. Results Of 105 stillbirths, 65 were fresh (62% and obstetric complications dominated the cause classification. Of 116 neonatal deaths, 87 were early and the major causes were intrapartum-related (28%, prematurity (23%, and severe infection (22%. Bereavement was associated with socioeconomic quintile, previous stillbirth, and number of antenatal care visits. We identified 201 individual delays in 121/187 birth narratives (65%. Overall, delays in receiving care after arrival at a health facility dominated and were mostly the result of referral from one institution to another. Most delays in seeking care were attributed to a failure to recognise symptoms of complications or their severity. Conclusions In Mumbai’s slum settlements, early neonatal deaths made up 75% of neonatal deaths and intrapartum-related complications were the greatest cause of mortality. Delays were identified in two-thirds of narratives, were predominantly related to the provision of care, and were often attributable to referrals between health providers. There is a need for clear protocols for care and transfer at each level of the health system, and an emphasis on rapid identification of problems and communication between health facilities. Trial registration ISRCTN96256793

  3. Morphological changes in aorto-coronary vein graft: The analysis of autopsy and biopsy material

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    Tati? Vujadin

    2004-01-01

    Full Text Available Background. Patients with implanted aortic coronary grafts have different survival time, which raises the question why the efficacy of graft implants is so poor. The aim of this study was to present the results of the analysis of morphological changes in the vein grafts taken after the death of patients who died after surgery in different time intervals, as well to present the analysis of the grafts obtained after surgical reintervention. Methods. The total number of 656 grafts of 308 dead patients was analyzed, as well as 76 grafts from 40 patients who underwent surgical reintervention. According to the duration of the graft since surgical intervention until death, all the analyzed changes were divided into two groups: a early changes and complications, and b late changes and complications in aorto-coronary vein grafts. Results. After the autopsy, 518 vein grafts from the first group were evaluated histopathologically. Changes were found in the form of small or large areas with peeled endothelium in 266 grafts, with the insudation of fibrin and thrombocytes in such places, subendothelial edema, and occlusive thrombosis of the graft lumen. Significant stenosis, which occurred distally from the anastomoses, was present in 118 grafts without changes in the walls of the graft, and there was significant narrowing of the graft lumen in 134 vein grafts due to intimal hyperplasia. In the second group, 138 grafts were histopathologically analyzed after autopsy. Significant hyperplasia was present in 117 grafts with the migration of smooth muscle cells from media into intima, and in 21 grafts there were atheromatous plaques. In 120 veins analyzed before the graft implantation, the lesion or the lack of endothelium was found, as well as the penetration of fibrin and blood elements and intimal hyperplasia. In 46 veins analyzed before the graft implantation, significant intimal hyperplasia with the elevated number of smooth muscle cells was found. Conclusion. The most frequent lesions in the grafts were the lesions of the endothelium, which caused thrombosis formation and lumen occlusion. Intimal hyperplasia in patients with longer survival time occurred due to the migration of smooth muscle cells from the media, or due to the formation of atherosclerotic plaques, which caused graft lumen stenosis or thrombosis.

  4. [An autopsied case of atypical presenile dementia which shows lobar atrophy, severe neurofibrillary tangles and calcification].

    Science.gov (United States)

    Ujihira, N; Hashizume, Y; Takagi, T; Ito, M

    1997-04-01

    We report an autopsy case of atypical presenile dementia. Shibayama, Kosaka and others had reported similar autopsy cases. These cases had the following common pathologic characteristics: circumscribed cerebral atrophy, diffuse neurofibrillary tangles (NFTs) noted in the cerebral cortex with few senile plaques (SPs), and pathological calcification. We propose the term "dementia with cerebral calcification and tangles" (DCCT) for this atypical presenile dementia. Our patient, who was female and died at the age of 65 years, also exhibited these characteristics. Her clinical diagnosis was Alzheimer's disease. She had developed apparent dementia at the age of 55. Psychological and neurological symptoms such as memory impairment, speech disturbance and abnormal behavior slowly progressed. Gradually, she had become bedridden in her own home. When she was 65 years old, she was admitted because of pneumonia, and died soon after. In the pathologic examination of our patient, the brain weight was 850 g, and severe cerebral atrophy predominant in the temporal lobe was noted. Microscopically, diffuse and numerous NFTs were also found in the cerebral cortex and brain stem. Some NFTs were observed in the dentate nucleus of the cerebellum. However, SPs were seldom noted. Calcifications were also found in the putamen, globus pallidus and cerebellar cortex. NFTs in our case had developed without the formation of SPs. The degree of the NFT formation was correlated to the extent of cerebral cortical atrophy and neuron loss. Therefore, we suspect that NFTs with neuron loss strongly contribute to clinical symptoms such as dementia. The distribution of NFTs resembles that in patients with Alzheimer's disease, they are more prominent in the temporal lobe in our case. Although there has not been any discussion about the findings of glial cells and neuropils in DCCT, our detailed examination showed argyrophilic structures in glial cells and in neuropils. Most of the glial cells appeared to be oligodendrocytes. Calcification is also a prominent characteristic of DCCT. Using analytical electron microscopy, we examined the area of calcification in the globus pallidus and cerebellum, and found an accumulation of both Fe and Ca. The role of calcification in the pathogenesis, however, remains unclear. It is very important to examine cases of atypical presenile dementia clinicopathologically, in order to study the correlation between NFTs and SPs in neurological disease, and to understand their pathogenetic significance. PMID:9248337

  5. Anatomopathological aspects of neurocysticercosis in autopsied patients / Aspectos anatomopatológicos da neurocisticercose em pacientes autopsiados

    Scientific Electronic Library Online (English)

    Ruy de Souza, Lino-Junior; Ana Carolina Guimarães, Faleiros; Marina Clare, Vinaud; Flávia Aparecida de, Oliveira; Janaína Valadares, Guimarães; Marlene Antônia dos, Reis; Vicente de Paula Antunes, Teixeira.

    2007-03-01

    Full Text Available 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 micr [...] oscopia 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 significante 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 w [...] as 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. Macroscopically, 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.

  6. Current (1986) status of the Japanese follow-up study of the Thorotrast patients, and its relationships to the statistical analysis of the autopsy series

    International Nuclear Information System (INIS)

    Although the Japanese Thorotrast study was limited by the number of cases that could be followed or autopsied, (286 and 333) the following conclusions were made:- 1. Shortening of the lifespan occurred in the intravascular Thorotrast follow-up cases as compared with their controls. 2. The incidence of malignant hepatic tumours, liver cirrhosis, blood diseases and carcinoma of the gall-bladder was significantly higher in the intravascular Thorotrast cases than in their controls. 3. A chronological change occurred in the distribution of histological types of Thorotrast-induced malignant hepatic tumours during the 42-year period from 1945 to 1986. 4. A significantly higher rate of malignant peritoneal tumours was proved in the intravascular Thorotrast autopsy series as compared with the control autopsy series. 5. From the relationship between the follow-up study and the autopsy series, the authors estimated that 2000-3000 Japanese lived more than 3 years after intravascular injection of Thorotrast. (author)

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

    OpenAIRE

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

    2013-01-01

    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. Qauji...

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

    OpenAIRE

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

    2011-01-01

    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 cancer rates in this area. Methods An epidemiologic study was designed to compare numbers of deaths and causes of death between the study areas with water pollution and the control areas without water pollution in S Co...

  9. Autopsy Findings of Brainstem in Head Trauma in Comparison with CT Scan Findings in Brain Trauma Ward in Tabriz, Iran

    Directory of Open Access Journals (Sweden)

    Shakeri Bavil Moslem

    2009-10-01

    Full Text Available Computed tomography (CT is now the primary diagnostic method for head trauma because of its ability to demonstrate the nature, extent, sites, and multiplicity of brain injuries. Although there have been numerous reports on the CT findings of most types of intracranial injury, the findings in brainstem injury have not been well described. This study aimed at comparing the autopsy findings of brainstem in head trauma in comparison with CT scan results. Two hundred patients with head trauma, who expired after a period of time of hospitalization, were assessed in a diagnostic value study. Brain stem involvement was determined by autopsy as well as CT scanning of the brain during their hospitalization. The results of the two methods were compared with each other, emphasizing on the type and location of probable lesions in the brain stem. Considering the autopsy as the method of the choice, sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of CT scan in brain stem lesions of patients with head trauma were calculated. The effect of primary cause of head trauma, survival time and Glasgow Coma Scale (GCS were evaluated, as well. Brain stem lesions were detected in 39 (19.5% patients in autopsy. However, CT scan revealed brain stem lesions in 23(11.5% cases. The sensitivity, specificity, PPV and NPV of CT scan was 59%, 100%, 100% and 91% respectively. The most common lesions of the brain stem region were as contusion of pons (8.5%, medulla (5% and midbrain (4.5%. There were 6 (3% cases of ponto-medullary junction tearing and 1 (0.5% case of cervico-medullary junction tearing. CT scan is a specific method of evaluating patients with probable brain stem injuries after head trauma, but low sensitivity limits its efficacy. Our results are in conformity with the reports in the literature.

  10. Autopsy-proven causes of death in lungs of patients immunocompromised by secondary interstitial pneumonia Causas de óbito por pneumonia intersticial secundária em autópsias pulmonares de pacientes imunocomprometidos

    OpenAIRE

    Alberto Antonio Terrabuio Junior; Edwin Roger Parra; Cecília Farhat; Vera Luiza Capelozzi

    2007-01-01

    PURPOSE: To present the more frequent associations found in autopsies of immunocompromised patients who developed secondary interstitial pneumonia as well as the risk of death (odds ratio) in having specific secondary interstitial pneumonia according to the cause of immunocompromise. METHOD: From January 1994 to March 2004, 17,000 autopsies were performed at Hospital das Clínicas, São Paulo University Medical School. After examining the pathology report review, we selected 558 of these auto...

  11. Review of Handbook of Autopsy Practice, Brenda L. Waters (Ed.). 4th edition, Humana Press (2009). ISBN: 978-1-58829-841-6

    DEFF Research Database (Denmark)

    Leth, Peter Mygind

    2010-01-01

    This 4th edition of Handbook of Autopsy Practice is a thoroughly updated version. Autopsy practice has undergone significant changes in recent time due to technological advancements such as molecular diagnostics, immunohistochemisty and the introduction of post-mortem imaging techniques. In the same period the autopsy rate in teaching hospitals has declined. A comprehensive and updated version is therefore most welcome. Part I have six completely new chapters, and contain an assortment of tools of great practical value for the forensic pathologist. There is for example a next-of-kin letter for the family of the deceased and a quality assurance worksheet. The text is written in a well-formulated language, and is not too long. The illustrations and photos are of a high quality. All photos are black-and-white. The book covers a broad area of relevance to autopsy practice, including specialized techniques used for post-mortem investigation of the cardio-vascular system, the nervous system and eye and adnexa. Autopsy microbiology, chemistry and chromosome analysis and autopsies of bodies containing radioactive material are also among the topics that are addressed in this handbook, as well as post-mortem imaging techniques. Part II begins with a list of special histologic stains, but the bulk is devoted to an alphabetic listing of major diseases with possible or expected findings and recommended procedures. This part has also been updated with new diseases and recent references. Part III provides a series of tables providing organ weights and body measurements for foetuses, children and adults. The Handbook of Autopsy Practice fulfils its purpose, and is a very worthwhile purchase for any autopsy facility.

  12. A semi-structured interview for psychological autopsy in suicide cases Entrevista semi-estruturada para autópsia psicológica em casos de suicídio

    OpenAIRE

    Blanca Guevara Werlang; Neury José Botega

    2003-01-01

    OBJECTIVE: To investigate the applicability and the interrater reliability of a Semi-Structured Interview for psychological autopsy in cases of suicide. METHOD: The Semi-Structured Interview for Psychological Autopsy (SSIPA) proposed in this paper consists of four modules which evaluate key-topics associated to suicide. In order to evaluate the instrument's applicability, a sample formed by 42 subjects related to 21 suicide cases was used. The interviews were tape-recorded first and then tran...

  13. Truncus arteriosus communis in a midtrimester fetus: Comparison of prenatal ultrasound and MRI with postmortem MRI and autopsy

    Energy Technology Data Exchange (ETDEWEB)

    Muehler, Matthias R.; Lembcke, Alexander; Fischer, Thomas; Kivelitz, Dietmar [CCM, Department of Radiology, Charite, Berlin (Germany); Rake, Anett; Chaoui, Rabih; Heling, Kay-Sven [CCM, Section for Prenatal Medicine, Department of Gynecology and Obstetrics, Charite, Berlin (Germany); Schwabe, Michael [CCM, Department of Pathology, Charite, Berlin (Germany); Planke, Christiane [Carl-Thiem-Klinikum Cottbus, Department of Pediatrics and Juvenile Medicine, Cottbus (Germany)

    2004-11-01

    Different techniques are used in fetal cardiology, and their accuracy has been demonstrated on several occasions. Color Doppler US has proved to be a reliable and valuable tool in the diagnosis of fetal cardiac abnormalities. Magnetic resonance imaging (MRI) of the fetal heart has, so far, played no role in prenatal diagnostics. We report on a truncus arteriosus communis diagnosed prenatally during a screening ultrasound at 22 weeks of gestation. In addition to real-time ultrasound and color Doppler echocardiography, fetal MRI was performed. Fetal echocardiography arose suspicion of a type I common trunk. Fetal MR showed solely a widened vessel coursing retrocardially and additionally an inhomogeneous fluid distribution of the lung not shown on prenatal US. After termination of pregnancy at 23 weeks of gestation, MR fetography and autopsy were performed, and both found a type II common trunk. MR autopsy of the heart was very reliable in this case and could be an alternative when fetal pathology is not available for different reasons. Postmortem MRI was also able to demonstrate the inhomogeneous fluid distribution in the lung, which was confirmed by autopsy. Fetal and postmortem MR was reliable in the detection of an inhomogeneous fluid distribution in the lung not shown on prenatal US, providing a relevant additional finding to US. Therefore, MRI should be used more often in fetal cardiology, although it still must be further developed. (orig.)

  14. Truncus arteriosus communis in a midtrimester fetus: Comparison of prenatal ultrasound and MRI with postmortem MRI and autopsy

    International Nuclear Information System (INIS)

    Different techniques are used in fetal cardiology, and their accuracy has been demonstrated on several occasions. Color Doppler US has proved to be a reliable and valuable tool in the diagnosis of fetal cardiac abnormalities. Magnetic resonance imaging (MRI) of the fetal heart has, so far, played no role in prenatal diagnostics. We report on a truncus arteriosus communis diagnosed prenatally during a screening ultrasound at 22 weeks of gestation. In addition to real-time ultrasound and color Doppler echocardiography, fetal MRI was performed. Fetal echocardiography arose suspicion of a type I common trunk. Fetal MR showed solely a widened vessel coursing retrocardially and additionally an inhomogeneous fluid distribution of the lung not shown on prenatal US. After termination of pregnancy at 23 weeks of gestation, MR fetography and autopsy were performed, and both found a type II common trunk. MR autopsy of the heart was very reliable in this case and could be an alternative when fetal pathology is not available for different reasons. Postmortem MRI was also able to demonstrate the inhomogeneous fluid distribution in the lung, which was confirmed by autopsy. Fetal and postmortem MR was reliable in the detection of an inhomogeneous fluid distribution in the lung not shown on prenatal US, providing a relevant additional finding to US. Therefore, MRI should be used more often in fetal cardiology, although it still must be further developed. (orig.)developed. (orig.)

  15. VALIDATION TEST FOR VERBAL AUTOPSY TOOL IN CAPTURING TB DEATH IN THE COMMUNITY IN METRO CITY, LAMPUNG PROVINCE

    Directory of Open Access Journals (Sweden)

    Sarimawar Djaja

    2012-11-01

    Full Text Available The TB death rate and the TB prevalence are considered two indicators of infectious diseases measured  to asses treatment progress to reach the MDGs target in 2015. Verbal autopsy is used to captured TB death cases happened  at home. The sample of " true” TB and "non” TB tests were selected from three gold standard hospital in Metro city. Verbal autopsy was conducted by well trained nurses/midwives from Puskesmas, interviewing  families having the death cases. Two reviewers  set up diagnoses based on the results of the VA. A referee team would decide the final cause of death (COD if the two diagnoses made by these two reviewers were unmatched. To avoid bias in this study, the blind technique was applied. The result of validation test shows out of 95 cases picked out from the three hospitals, only 65 of them were available for interview, 16 were defined to be TB cases and the other 49 cases were non TB, based as gold standard. There were 13 cases of well matched diagnoses between VA result and gold standard with Sensitivity value of 81 per cent (13 per 16. Twenty one death cases were defined TB through VA, the Positive Predictive Value was then 62 per cent (13 per 21. Those result is not much difference with the other place. The quality to determine the cause of death should be improved based on the /CD-10 mortality coding.   Key words: Validation, verbal autopsy, tuberculosis

  16. Ostium secundum atrial septal defect-related post-partum death of an adult: An autopsy case

    Directory of Open Access Journals (Sweden)

    Eyyüp Y?lmaz

    2012-09-01

    Full Text Available Atrial Septal Defect (ASD is the most common type ofcongenital heart disease in adolescents and adults with afrequency of 10-15 %. Ostium secundum type ASD has amultifactorial heredity pattern and is almost always sporadic.Herein, we presented a maternal mortality case of ASDthat died after nine days after delivery. She applied to thehospital three times with non-specific symptoms but diedwithout an accurate diagnosis. At autopsy, there was evidenceof episiotomy in recent delivery in genital region.The weight of the heart was 380 grams, hypertrophy ofpapillary muscles and an ostium secundum type ASDwith 1,6 x 1,1 cm dimensions were detected. Microscopicexamination of heart sections revealed hypertrophy, hyperemia,and focal, minimal colliquative myocytolysis.Electrocardiogram findings and autopsy findings wereevaluated together and in conclusion, our opinion on thecause of death was circulatory disturbance resulting fromchronic heart disease.Because of this, congenital heart disease which is a rarepathology and a cause of death in adult population, wepresented the findings of this case.Key words: Congenital heart disease, atrial septal defect,ostium secundum, maternal mortality, autopsy.

  17. Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach

    Science.gov (United States)

    Castillo, Paola; Ussene, Esperança; Ismail, Mamudo R.; Jordao, Dercio; Lovane, Lucilia; Carrilho, Carla; Lorenzoni, Cesaltina; Lacerda, Marcus V.; Palhares, Antonio; Rodríguez-Carunchio, Leonardo; Martínez, Miguel J.; Vila, Jordi; Bassat, Quique; Menéndez, Clara; Ordi, Jaume

    2015-01-01

    Background and Aims Complete diagnostic autopsies (CDA) remain the gold standard in the determination of cause of death (CoD). However, performing CDAs in developing countries is challenging due to limited facilities and human resources, and poor acceptability. We aimed to develop and test a simplified minimally invasive autopsy (MIA) procedure involving organ-directed sampling with microbiology and pathology analyses implementable by trained technicians in low- income settings. Methods A standardized scheme for the MIA has been developed and tested in a series of 30 autopsies performed at the Maputo Central Hospital, Mozambique. The procedure involves the collection of 20 mL of blood and cerebrospinal fluid (CSF) and puncture of liver, lungs, heart, spleen, kidneys, bone marrow and brain in all cases plus uterus in women of childbearing age, using biopsy needles. Results The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain. The amount of tissue obtained in the procedure varied from less than 10 mm2 for the lung, spleen and kidney, to over 35 mm2 for the liver and brain. A CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs. Conclusions A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses. This procedure could improve the determination of CoD in developing countries. PMID:26126191

  18. Pattern of suicide: a review of autopsies conducted at the University Hospital, Kuala Lumpur.

    Science.gov (United States)

    Nadesan, K

    1999-12-01

    Suicide is one of the ten leading causes of death in the world, accounting for more than 400,000 deaths annually. The pattern of suicide and the incidence of suicide vary from country to country. Cultural, religious and social values play some role in suicide. Compared to the West and some of the countries in the Asian region the incidence of suicide is low in Malaysia. A three-year retrospective study of all the autopsies performed at the University Hospital, Kuala Lumpur was analysed and the cases that were definitely determined as suicides were further studied. 48.8% of all suicides were ethnic Indians though Indians formed only 8% of the Malaysian population. 38.1% of suicides were Chinese who formed 26% of the population while only 3.6% were Malays, who formed 59% of the population. The preferred methods of suicide were poisoning and hanging. The majority were in the age group 20-40 yr. The study may have missed some cases that would have been wrongly concluded as accidental deaths and a few others where the police would have released the bodies without postmortem examinations. PMID:11068413

  19. Autopsy findings of the first and second filial generations of atomic bomb survivors

    International Nuclear Information System (INIS)

    Autopsy findings of 652 fetuses whose parents or one parent were exposed to the Atomic Bomb (F1) and 115 fetuses which had one or two grandparents exposed (F2) were compared with that of 8570 fetuses whose parents were not exposed (control). The F1 fetuses have been collected since 1963 and F2 fetuses since 1971 voluntarily in Hiroshima. The findings were classified according to the types of delivery and to the distances away from the hypocenter where the parents and grandparents were exposed. Many normal cases in the group of artificial abortions and many malformations and pathological findings in the group of spontaneous abortions were found in both groups of F1 and F2. The malformations were cardiovascular, central nervous and urogenital system, quantitatively in that order, in both groups of F1 and F2. Although there were a few cases of cystic kidney and chondrodystrophy which belong to autosomal dominant and osteogenesis imperfecta which belong to autosomal recessive, these cases were not correlated with the distance. Most cases of malformation which belong to the multifactorial inheritance were found in each organ. No peculiar malformation was found in the groups of F1 and F2. (author)

  20. Autopsy studies of Hashimoto's thyroiditis in Hiroshima and Nagasaki (1954-1974)

    International Nuclear Information System (INIS)

    The authors examined 155 autopsy cases of Hashimoto's thyroiditis in the Life Span Study sample including both A-bomb survivors and controls in Hiroshima and Nagasaki (1954 to 1974). Hashimoto's thyroiditis was classified into lymphoid, diffuse and fibrous types and the following results were obtained. No difference existed in the effects of A-bomb radiation in the incidence and ATB (At the time of the A-bomb). The ration of males to females did not reveal statistical significance, even though reversed ratio was noted in the high dose group. The variation of thyroid gland weight in T65 dose or by variant showed no significant pattern, even though the smallest average weight was found in the highest radiation exposure group. The complication in the patients with Hashimoto's thyroiditis were noted to have high prevalance of ovarian cancer and low prevalence of stomach cancer and total cancer. Only two patients with Hashimoto's thyroiditis were found to be complicated with thyroid carcinoma. Among collagen diseases, the prevalence of rheumatic fever and rheumatoid arthritis was high as complication. And the prevance of combined diseases suggested that no late effect of A-bomb radiation existed. (author)

  1. Why did ancient people have atherosclerosis?: from autopsies to computed tomography to potential causes.

    Science.gov (United States)

    Thomas, Gregory S; Wann, L Samuel; Allam, Adel H; Thompson, Randall C; Michalik, David E; Sutherland, M Linda; Sutherland, James D; Lombardi, Guido P; Watson, Lucia; Cox, Samantha L; Valladolid, Clide M; Abd El-Maksoud, Gomaa; Al-Tohamy Soliman, Muhammad; Badr, Ibrahem; el-Halim Nur el-Din, Abd; Clarke, Emily M; Thomas, Ian G; Miyamoto, Michael I; Kaplan, Hillard S; Frohlich, Bruno; Narula, Jagat; Stewart, Alexandre F R; Zink, Albert; Finch, Caleb E

    2014-06-01

    Computed tomographic findings of atherosclerosis in the ancient cultures of Egypt, Peru, the American Southwest and the Aleutian Islands challenge our understanding of the fundamental causes of atherosclerosis. Could these findings be true? Is so, what traditional risk factors might be present in these cultures that could explain this apparent paradox? The recent computed tomographic findings are consistent with multiple autopsy studies dating as far back as 1852 that demonstrate calcific atherosclerosis in ancient Egyptians and Peruvians. A nontraditional cause of atherosclerosis that could explain this burden of atherosclerosis is the microbial and parasitic inflammatory burden likely to be present in ancient cultures inherently lacking modern hygiene and antimicrobials. Patients with chronic systemic inflammatory diseases of today, including systemic lupus erythematosus, rheumatoid arthritis, and human immunodeficiency virus infection, experience premature atherosclerosis and coronary events. Might the chronic inflammatory load of ancient times secondary to infection have resulted in atherosclerosis? Smoke inhalation from the use of open fires for daily cooking and illumination represents another potential cause. Undiscovered risk factors could also have been present, potential causes that technologically cannot currently be measured in our serum or other tissue. A synthesis of these findings suggests that a gene-environmental interplay is causal for atherosclerosis. That is, humans have an inherent genetic susceptibility to atherosclerosis, whereas the speed and severity of its development are secondary to known and potentially unknown environmental factors. PMID:25667093

  2. Five years audit for presence of toxic agents/drug of abuse at autopsy

    International Nuclear Information System (INIS)

    Objective: To know the frequency of fatal poisoning in Peshawar regarding the toxic agents mostly involved and year wise percentage. To know the age group and the gender that is most vulnerable to fatal poisoning. Results: Poisoning was the cause of death in 1.48% of the total autopsies conducted during the five years. Males were more involved than the females, 90.38%. Suicidal poisoning was present in 17.30% of the total cases and accidental poisoning was found in 80.72% cases, while homicidal cases were 1.29% only. Diacetylmorphine (heroin) was the most commonly involved agent, 65.38%, of the total cases. The incidence of poisoning was more during the third and fourth decades of life. Conclusion: Diacetylmorphine (heroin) was the main causative agent involved in young males due to accidental over-dosage. Accidental and suicidal deaths should not be considered as inevitable. More elaborative studies are required in this area of recent research to adopt appropriate and adequate measures to save precious lives.(author)

  3. Hiperinfecção por Strongyloides stercoralis: relato de caso autopsiado Strongyloides stercoralis hyperinfection: autopsy case report

    Directory of Open Access Journals (Sweden)

    Moema Gonçalves Pinheiro Veloso

    2008-08-01

    Full Text Available Infecção assintomática por Strongyloides stercoralis pode resultar em doença potencialmente fatal em pacientes imunodeprimidos. Os autores relatam caso de hiperinfecção por Strongyloides stercoralis descoberto à autópsia, enfatizando aspectos clinicopatológicos, em homem de 55 anos, em tratamento para mieloma múltiplo. Apresentava, havia um dia, cefaléia intensa, dor abdominal e oligúria desenvolvendo insuficiência respiratória aguda e choque séptico. Devido à dificuldade no diagnóstico, o tratamento empírico antes do início da terapia imunossupressora pode ser a melhor estratégia para prevenir a hiperinfecção pelo verme.Asymptomatic infection due to Strongyloides stercoralis may result in potentially fatal disease in immunodepressed patients. A case of Strongyloides stercoralis hyperinfection discovered at autopsy in a 55-year-old man who had been undergoing treatment for multiple myeloma is reported, emphasizing the clinical and pathological findings. One day earlier, he presented severe headache, abdominal pain and oliguria, from which he developed acute respiratory failure and septic shock. Because of difficulty in reaching this diagnosis, empirical treatment before starting immunosuppressive therapy may be the best strategy for preventing hyperinfection by this worm.

  4. LA AUTOPSIA PSICOLÓGICA COMO INSTRUMENTO DE INVESTIGACIÓN PSYCHOLOGYCAL AUTOPSY AS AN INVESTIGATION TOOL

    Directory of Open Access Journals (Sweden)

    IVÁN ALBERTO JIMÉNEZ ROJAS

    2001-09-01

    Full Text Available Se define el concepto de autopsia psicológica desde su origen en los años cincuenta en California cuando empezó a utilizarse buscando un acercamiento a la comprensión de las circunstancias que rodearon la muerte de un individuo, investigando retrospectivamente sus características de personalidad y las condiciones que tuvo en vida. Se establecen las características del método y su utilidad en psiquiatría clínica y en psiquiatría forense, siendo relevante su aplicación en psiquiatría forense, siendo relevante su aplicaci ón potencial en el diseño de políticas de promoción de la salud y prevención de suicidio, homicidio o accidentes. Finalmente se resumen algunos resultados obtenidos mediante su aplicación en el Instituto Nacional de Medicina Legal y Ciencias Forenses de Colombia.From its origins in California, in the fifties, the concept of psychological autopsy is defined. Understand of circunstances around the death of an individual, along with the study of his or her distinctive personality traits and life condition constitute its aim. Method characteristics and its usefulness in clinical forensic psychiatry, and accidents programs in suicide, homicide and accidents are established. Finally, some results in the National Institute of Legal Medicine and Forensic of Colombia are here presented.

  5. Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death

    Directory of Open Access Journals (Sweden)

    Salge Ana Karina Marques

    2004-01-01

    Full Text Available PURPOSE: The purpose of this study was to identify the possible alteration in the thickness of the epithelium basal membrane of the vocal cords and correlate it with the cause of death. METHOD: Larynxes collected from adult autopsies during the period of 1993 to 2001 were utilized. We used the hematoxylin-eosin and periodic acid-Schiff staining methods for the morphological and morphometric analysis. RESULTS: Sixty-six vocal cords were analysed; increased thickness was identified in 14 cases (21.2%, with equal proportions between the genders. Increased vocal-cord thickness was more frequent in patients of the white ethnicity (12 cases, 85.7%. Respiratory alterations were found in 10 (71.4% of the cases with increased vocal-cord thickness. Of the patients that were maintained with mechanical ventilation before death, 7 (18.4% had thickening of the basal membrane. Among the smokers, 9 (19.63% had basal membrane thickening. CONCLUSION: No statistically significant differences were found between the cases in which the cause of death was related to respiratory diseases as compared to non-respiratory diseases and the thickening of the basal membrane of the vocal cords. However, new studies are needed in order to verify the etiopathogenesis of this thickening.

  6. Statistical studies on heart disease of the pathological autopsy cases in the Atomic Bomb Hospital

    International Nuclear Information System (INIS)

    Of 1230 autopsied cases in the Atomic Bomb Hospital and in the Red-Cross Hospital from 1956 to March, 1975, a statistical study was made on 118 cases in which primary or secondary heart disease had been found. The results are as follows. The incidence of myocardial infarction was 2.4 times higher in the group exposed to the atomic bomb within 2 km distance from the bombed area than that it was in the unexposed group. The incidence of acquired valvular disease was 4.1 times higher in the exposed group than in the unexposed group. From the standpoint of the incidence of myocardiosis, there was no difference between the groups. The incidence of pericarditis was 1.5 times higher in the exposed group than in the unexposed group. The incidence of cor pulmonale was 1.8 times higher in the exposed group than in the unexposed group. The incidence of other heart disease including congenital disease was, however, 1.6 times higher in the unexposed group than in the exposed group. The incidence of general heart disease was 1.7 times higher in the exposed group than in the unexposed group. The incidence of hypertrophy of the heart (more than 400 g) was 1.2 times higher in the exposed group than in the unexposed group. (Namekawa, K.)

  7. Psychological Autopsy and Necropsy of an Unusual Case of Suicide by Intravenous Toluene

    Science.gov (United States)

    Kulkarni, Ranganath R.; Hemanth Kumar, RG; Kulkarni, Pratibha R.; Kotabagi, Raghavendra B.

    2015-01-01

    Toluene (methylbenzene; volatile hydrocarbon) is an industrial solvent that causes major injury to the lungs; the organ being the first capillary bed encountered. We report an unusual case of suicide by a 24-year-old male, paramedical professional, with fatal outcome within 16 h of intentional, intravenous self-administration of toluene, with clinical presentation of acute respiratory distress syndrome. Psychological autopsy revealed severe depressive disorder and solvent (inhalant) abuse, with marital disharmony as the precipitating stressor for suicide. Necropsy revealed diffuse congestion of internal organs like lungs and liver, epicardial petechial hemorrhages, and gastric hemorrhages. Treatment of toluene poisoning includes supportive care as no specific antidote is available. Early and aggressive management may be conducive to a favorable outcome with minimal residual pulmonary sequelae. Relevant literature of toluene poisoning was identified via PubMed, PubChem, ToxNet, Hazardous Substances Data Bank (HSDB), Embase, and PsycINFO. To our knowledge, this is the first case of suicide by intravenous administration of toluene in the literature. PMID:25969615

  8. Hiperinfecção por Strongyloides stercoralis: relato de caso autopsiado / Strongyloides stercoralis hyperinfection: autopsy case report

    Scientific Electronic Library Online (English)

    Moema Gonçalves Pinheiro, Veloso; Anita Sperandio, Porto; Mário, Moraes.

    2008-08-01

    Full Text Available Infecção assintomática por Strongyloides stercoralis pode resultar em doença potencialmente fatal em pacientes imunodeprimidos. Os autores relatam caso de hiperinfecção por Strongyloides stercoralis descoberto à autópsia, enfatizando aspectos clinicopatológicos, em homem de 55 anos, em tratamento pa [...] ra mieloma múltiplo. Apresentava, havia um dia, cefaléia intensa, dor abdominal e oligúria desenvolvendo insuficiência respiratória aguda e choque séptico. Devido à dificuldade no diagnóstico, o tratamento empírico antes do início da terapia imunossupressora pode ser a melhor estratégia para prevenir a hiperinfecção pelo verme. Abstract in english Asymptomatic infection due to Strongyloides stercoralis may result in potentially fatal disease in immunodepressed patients. A case of Strongyloides stercoralis hyperinfection discovered at autopsy in a 55-year-old man who had been undergoing treatment for multiple myeloma is reported, emphasizing t [...] he clinical and pathological findings. One day earlier, he presented severe headache, abdominal pain and oliguria, from which he developed acute respiratory failure and septic shock. Because of difficulty in reaching this diagnosis, empirical treatment before starting immunosuppressive therapy may be the best strategy for preventing hyperinfection by this worm.

  9. Measurement of asbestos bodies in lung tissue of autopsy cases diagnosed with primary lung cancer

    International Nuclear Information System (INIS)

    To investigate the relation between asbestos-related lung cancer and the concentration of asbestos bodies in lung tissue, we analyzed the concentration in 24 autopsy cases diagnosed with primary lung cancer, with regard to the gender, age, histological type of lung cancer and occupation of each case. The asbestos bodies were measured according to Kohyama's method. Positive cases (more than 5,000 bodies per 1 g of dry lung tissue) were further analyzed for asbestosis and pleural plaques by chest X-ray and chest CT. Two cases exhibited more than 5,000 bodies, five cases between 1,000 and 5,000, and seventeen cases less than 1,000. The occupation of the two positive cases was not informative: one demonstrated neither asbestosis nor pleural plaques, and the other showed only pleural plaques. Although the number of cases of asbestos-related lung cancer is minimal among all lung cancer cases, the number of the former may exceed that of mesothelioma patients. Not only physicians but also radiologists, surgeons and pathologists need to collaborate in the diagnosis of asbestos-related lung cancer. (author)

  10. LA AUTOPSIA PSICOLÓGICA COMO INSTRUMENTO DE INVESTIGACIÓN / PSYCHOLOGYCAL AUTOPSY AS AN INVESTIGATION TOOL

    Scientific Electronic Library Online (English)

    IVÁN ALBERTO, JIMÉNEZ ROJAS.

    2001-09-01

    Full Text Available Se define el concepto de autopsia psicológica desde su origen en los años cincuenta en California cuando empezó a utilizarse buscando un acercamiento a la comprensión de las circunstancias que rodearon la muerte de un individuo, investigando retrospectivamente sus características de personalidad y l [...] as condiciones que tuvo en vida. Se establecen las características del método y su utilidad en psiquiatría clínica y en psiquiatría forense, siendo relevante su aplicación en psiquiatría forense, siendo relevante su aplicaci ón potencial en el diseño de políticas de promoción de la salud y prevención de suicidio, homicidio o accidentes. Finalmente se resumen algunos resultados obtenidos mediante su aplicación en el Instituto Nacional de Medicina Legal y Ciencias Forenses de Colombia. Abstract in english From its origins in California, in the fifties, the concept of psychological autopsy is defined. Understand of circunstances around the death of an individual, along with the study of his or her distinctive personality traits and life condition constitute its aim. Method characteristics and its usef [...] ulness in clinical forensic psychiatry, and accidents programs in suicide, homicide and accidents are established. Finally, some results in the National Institute of Legal Medicine and Forensic of Colombia are here presented.

  11. Autopsy features in a newborn baby affected by a central congenital diaphragmatic hernia.

    Science.gov (United States)

    Bolino, Giorgio; Gitto, Lorenzo; Serinelli, Serenella; Maiese, Aniello

    2015-03-01

    Congenital diaphragmatic hernia is a congenital malformation of the diaphragm, resulting in the herniation of the abdominal organs into the thoracic cavity. The most common types of congenital diaphragmatic hernia are Bochdalek hernia (postero-lateral hernia), Morgagni hernia (anterior defect), and diaphragm eventration (abnormal displacement of part or all of an otherwise intact diaphragm into the chest cavity). Congenital diaphragmatic hernia is a life-threatening pathology in infants, and a major cause of death due to pulmonary hypoplasia and pulmonary hypertension. We present a fatal case of congenital diaphragmatic hernia in a newborn. At the autopsy, a central defect of the diaphragm was found, 8?×?5?cm in size, that led to a herniation of the small intestine, the right lobe of the liver, and the right adrenal gland into the thorax. An esophageal atresia was associated with the congenital diaphragmatic hernia. The lungs showed severe hypoplasia and atelectasia. Physicians should pay attention to a prenatal diagnosis of congenital diaphragmatic hernia in order to prevent newborn fatalities. PMID:25573226

  12. Pathology of the heart in AIDS. A study of 60 consecutive autopsies.

    DEFF Research Database (Denmark)

    Hansen, B F

    1992-01-01

    Cardiac disease and cardiac death in AIDS patients is seldom reported. In recent years minor cardiac abnormalities have been demonstrated, especially by echocardiography. Cardiac pathology in AIDS patients is here reported from 60 consecutive autopsies where the heart was investigated either using single samples of ventricular myocardium (the first 21 cases) or by an examination of the whole heart (the last 39 cases). Myocarditis according to the Dallas criteria was seen in 25 of 60 cases (42%), and in seven of these cases a probable pathogen (Toxoplasma gondii, cytomegalovirus, fungi) was demonstrated. Diffuse myocardial fibrosis was seen in 40 of 60 cases (67%) and is considered to be partly due to repair after myocyte necrosis/myocarditis. A myocardium thus weakened might not be able to meet an increase in functional demand, and in 15 of the 39 cases (38%) where an examination of the whole heart was performed, there was dilation and/or hypertrophy of the right ventricle. This is in agreement with our knowledge that the main diseases and main causes of death in AIDS patients are pulmonary. Survival time in AIDS is increasing due to ever improving symptomatic treatment, and the results of this study indicate that the prevalence of especially right-sided heart failure will increase.

  13. A hospital based autopsy study of 50 cases at combined military hospital (cmh), sialkot

    International Nuclear Information System (INIS)

    To analyze the pattern of deaths on autopsy carried out on Armed Forces personnel in CMH Sialkot. Study Design: Retrospective analytical study Place and Duration of Study: Combined Military Hospital Sialkot (CMH), from 2009 to 2012 Materials and Methods: In a total of fifty (50) cases detailed postmortems were carried out and gross features on external examination and different systemic examinations were recorded. Histopathology of various organs was done in all cases. Chemical and toxicological examination of various abdominal viscera was carried out in all sudden and suspicious deaths. Results: Ischemic Heart Disease (IHD) was most common cause of death (38%) followed by road traffic accidents (14%) and electrocution (8%). Sudden adult death syndrome accounted for 4 cases of deaths. Other causes were drowning, cerebral malaria, heat stroke, gunshot wounds, myocarditis, brain hemorrhage, meningitis and diabetic ketoacidosis. Most of these cases were young soldiers (n=30) followed by Non-Commissioned Officers (n=17). Conclusion: A large number of our young soldiers dying of heart problems is an alarming situation. Awareness among the troops of various risk factors is most important. Precautionary measures against preventable causes should be taken. (author)

  14. The importance of microbiological testing for establishing cause of death in 42 forensic autopsies.

    Science.gov (United States)

    Christoffersen, S

    2015-05-01

    Microorganisms have always been one of the great challenges of humankind, being responsible for both high morbidity and mortality throughout history. In a forensic setting microbiological information will always be difficult to interpret due to lack of antemortem information and changes in flora postmortem. With this study we aim to review the use of microbiological procedures at our forensic institute. In a retrospective study including 42 autopsies performed at our Institute, where microbiological test had been applied, analyses were made with regard to: type of microbiological tests performed, microorganisms found, histological findings, antemortem information, C-reactive protein measurement and cause of death. Fiftyone different microorganisms were found distributed among 37 cases, bacteria being the most abundant. Nineteen of the cases were classified as having a microbiological related cause of death. C-reactive protein levels were raised in 14 cases of the 19 cases, histological findings either supported or were a decisive factor for the classification of microbiologically related cause of death in 14 cases. As a multitude of abundant microorganisms are able to cause infection under the right circumstances, all findings should be compared to anamnestic antemortem information, before conclusions are drawn. A definite list of true pathogens is nearly impossible to compile. PMID:25769131

  15. Molecular autopsy in young sudden cardiac death victims with suspected cardiomyopathy

    DEFF Research Database (Denmark)

    Larsen, Maiken Kudahl; Nissen, P H

    2011-01-01

    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.

  16. The importance of microbiological testing for establishing cause of death in 42 forensic autopsies

    DEFF Research Database (Denmark)

    Christoffersen, SØren

    2015-01-01

    Microorganisms have always been one of the great challenges of humankind, being responsible for both high morbidity and mortality throughout history. In a forensic setting microbiological information will always be difficult to interpret due to lack of antemortem information and changes in flora postmortem. With this study we aim to review the use of microbiological procedures at our forensic institute. In a retrospective study including 42 autopsies performed at our Institute, where microbiological test had been applied, analyses were made with regard to: type of microbiological tests performed, microorganisms found, histological findings, antemortem information, C-reactive protein measurement and cause of death. Fiftyone different microorganisms were found distributed among 37 cases, bacteria being the most abundant. Nineteen of the cases were classified as having a microbiological related cause of death. C-reactive protein levels were raised in 14 cases of the 19 cases, histological findings either supported or were a decisive factor for the classification of microbiologically related cause of death in 14 cases. As a multitude of abundant microorganisms are able to cause infection under the right circumstances, all findings should be compared to anamnestic antemortem information, before conclusions are drawn. A definite list of true pathogens is nearly impossible to compile.

  17. Fatal disseminated mucormycosis in a patient with mantle cell non-hodgkin's lymphoma: an autopsy case

    Scientific Electronic Library Online (English)

    Inci, Alacacioglu; Aydanur, Kargi; Mehmet Ali, Ozcan; Ozden, Piskin; Cilem, Solak; Mustafa, Secil; Mehtat, Unlu; Fatih, Demirkan; Guner Hayri, Ozsan; Bulent, Undar.

    2009-06-01

    Full Text Available A patient with mantle cell non-Hodgkin's lymphoma presented herself with fever, nausea, right upper quadrant pain on the 7th day of R-CHOP chemotherapy. After hospitalization with the suspicion of acute cholecystitis, she received antibiotherapy with G-CSF because of emerging neutropenia at the 10th [...] day of chemotherapy. Abdominal computed tomography revealed small infarcts in the spleen and kidneys. The echymotic lesion which developed on her right lateral malleolus, became bullous in the following days and treated as ecthyma gangrenosum. Altough the patient was afebrile with a normal neutrophil count on the third day of antibiotherapy, she developed acute renal failure and deteriorated rapidly. The patient underwent hemodialysis but expired on the 10th day of hospitalization. Post mortem autopsy findings showed ischemic infarction and necrosis of parenchyma due to mycotic thrombosis of arteries and veins of many organs (heart, lung, diaphgram, kidneys, spleen, gut mucosa) as well as invasion of vessel walls and parenchyma by mucor. We reviewed mucormycosis in the light of this case.

  18. 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)

  19. Statistical analysis of a LASL study of plutonium in US autopsy tissue

    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 tissues for each individual. The original objective of the program was to determine the level of plutonium in human tissues due solely to fallout 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

  20. “Even if I were to consent, my family will never agree”: exploring autopsy services for posthumous occupational lung disease compensation among mineworkers in South Africa

    Directory of Open Access Journals (Sweden)

    Audrey V. Banyini

    2013-01-01

    Full Text Available Context: In the South African mining sector, cardiorespiratory-specific autopsies are conducted under the Occupational Diseases in Mines and Works Act (ODMWA on deceased mineworkers to determine eligibility for compensation. However, low levels of autopsy utilisation undermine the value of the service. Objective: To explore enablers and barriers to consent that impact on ODMWA autopsy utilisation for posthumous monetary compensation. Methods: In-depth interviews were conducted with mineworkers, widows and relatives of deceased mineworkers as well as traditional healers and mine occupational health practitioners. Results: A range of socio-cultural barriers to consent for an autopsy was identified. These barriers were largely related to gendered power relations, traditional and religious beliefs, and communication and trust. Understanding these barriers presents opportunities to intervene so as to increase autopsy utilisation. Conclusions: Effective interventions could include engagement with healthy mine-workers and their families and re-evaluating the permanent removal of organs. The study adds to our understanding of utilisation of the autopsy services.

  1. Validity of verbal autopsy for ascertaining the causes of stillbirth / Validité de l'autopsie verbale dans la détermination des causes de mortinaissance / Validez de las investigaciones verbales para determinar las causas de la mortinatalidad

    Scientific Electronic Library Online (English)

    Arun K, Aggarwal; Vanita, Jain; Rajesh, Kumar.

    2011-01-01

    Full Text Available OBJETIVO: Validar las entrevistas verbales a parientes y allegados para determinar las causas de la mortinatalidad que utiliza la Organización Mundial de la Salud (OMS), empleando el diagnóstico hospitalario de las causas subyacentes a la mortinatalidad («criterio de referencia») y comparar la propo [...] rción de mortinatos atribuidos a determinadas causas específicas, a través de la valoración del hospital, en comparación con los resultados de las investigaciones verbales. MÉTODOS: Realizamos un estudio prospectivo de todos los mortinatos que nacieron en un hospital de Chandigarh (India) entre el 15 de abril de 2006 y el 31 de marzo de 2008 y cuya causa de defunción se diagnosticó dentro de un plazo de 2 días. Todas las madres debían encontrarse como mínimo en la semana 24 de gestación y vivir dentro de un radio de 100 km del hospital. Para las entrevistas verbales, los trabajadores en el terreno visitaron a las madres entre las 4 y las 6 semanas posteriores a la mortinatalidad. Dos obstetras independientes revisaron los resultados de las autopsias y, en caso de desacuerdo, se solicitó la participación de un tercer experto. Se comparó la frecuencia de las causas de la mortinatalidad, según lo establecido por la valoración hospitalaria y por las investigaciones verbales. RESULTADOS: Tanto la valoración hospitalaria como la entrevista verbal coincidieron en cuáles eran las cinco causas de mortinatalidad más frecuentes: preeclampsia (30%), hemorragia prenatal (16%), enfermedad subyacente de la madre (12%), malformaciones congénitas (12%) y complicaciones obstétricas (10%). La precisión general del diagnóstico mediante investigación verbal, en comparación con el diagnóstico basado en la información hospitalaria para las cinco causas más frecuentes de mortinatalidad, fue del 64%. Las áreas bajo la curva de eficacia diagnóstica (ROC) fueron: para las malformaciones congénitas, 0,91 (intervalo de confianza del 95%, IC: 0,83-0,97); enfermedad pre-gestacional de la madre, 0,75 (95%, IC: 0,65-0,84); preeclampsia, 0,76 (95%, IC: 0,69-0,81); hemorragia prenatal, 0,76 (95%, IC: 0,67-0,84) y complicaciones obstétricas, 0,82 (95%, CI: 0,71-0,93). CONCLUSION: La herramienta de investigación verbal de la mortinatalidad que emplea la OMS puede ofrecer unas estimaciones razonablemente aceptables de las causas subyacentes más frecuentes a la mortinatalidad en los ámbitos con recursos limitados, en los que la causa de mortinatalidad pueda no estar certificada por un médico. Abstract in english OBJECTIVE: To validate the verbal autopsy tool for stillbirths of the World Health Organization (WHO) by using hospital diagnosis of the underlying cause of stillbirth (the gold standard) and to compare the fraction of stillbirths attributed to various specific causes through hospital assessment ver [...] sus verbal autopsy. METHODS: In a hospital in Chandigarh, we prospectively studied all stillbirths occurring from 15 April 2006 to 31 March 2008 whose cause was diagnosed within 2 days. All mothers had to be at least 24 weeks pregnant and live within 100 km of the hospital. For verbal autopsy, field workers visited mothers 4 to 6 weeks after the stillbirth. Autopsy results were reviewed by two independent obstetricians and disagreements were resolved by engaging a third expert. Causes of stillbirths as determined by hospital assessment and verbal autopsy were compared in frequency. FINDINGS: Hospital assessment and verbal autopsy yielded the same top five underlying causes of stillbirth: pregnancy-induced hypertension (30%), antepartum haemorrhage (16%), underlying maternal illness (12%), congenital malformations (12%) and obstetric complications (10%). Overall diagnostic accuracy of verbal autopsy diagnosis versus hospital-based diagnosis for all five top causes of stillbirth was 64%. The areas under the receiver operator characteristic curve (ROC) were, for congenital malformations, 0.91 (95% confidence interval, CI: 0.83-0.97); pre-gestational maternal illness, 0.75 (95% CI: 0.65-0.84);

  2. Social autopsy for maternal and child deaths: a comprehensive literature review to examine the concept and the development of the method

    Directory of Open Access Journals (Sweden)

    Koffi Alain K

    2011-08-01

    Full Text Available Abstract "Social autopsy" refers to an interview process aimed at identifying social, behavioral, and health systems contributors to maternal and child deaths. It is often combined with a verbal autopsy interview to establish the biological cause of death. Two complementary purposes of social autopsy include providing population-level data to health care programmers and policymakers to utilize in developing more effective strategies for delivering maternal and child health care technologies, and increasing awareness of maternal and child death as preventable problems in order to empower communities to participate and engage health programs to increase their responsiveness and accountability. Through a comprehensive review of the literature, this paper examines the concept and development of social autopsy, focusing on the contributions of the Pathway Analysis format for child deaths and the Maternal and Perinatal Death Inquiry and Response program in India to social autopsy's success in meeting key objectives. The Pathway Analysis social autopsy format, based on the Pathway to Survival model designed to support the Integrated Management of Childhood Illness approach, was developed from 1995 to 2001 and has been utilized in studies in Asia, Africa, and Latin America. Adoption of the Pathway model has enriched the data gathered on care seeking for child illnesses and supported the development of demand- and supply-side interventions. The instrument has recently been updated to improve the assessment of neonatal deaths and is soon to be utilized in large-scale population-representative verbal/social autopsy studies in several African countries. Maternal death audit, starting with confidential inquiries into maternal deaths in Britain more than 50 years ago, is a long-accepted strategy for reducing maternal mortality. More recently, maternal social autopsy studies that supported health programming have been conducted in several developing countries. From 2005 to 2009, 10 high-mortality states in India conducted community-based maternal verbal/social autopsies with participatory data sharing with communities and health programs that resulted in the implementation of numerous data-driven maternal health interventions. Social autopsy is a powerful tool with the demonstrated ability to raise awareness, provide evidence in the form of actionable data and increase motivation at all levels to take appropriate and effective actions. Further development of the methodology along with standardized instruments and supporting tools are needed to promote its wide-scale adoption and use.

  3. Families' reflections on the process of brain donation following coronial autopsy.

    Science.gov (United States)

    Sundqvist, Nina; Garrick, Therese; Harding, Antony

    2012-03-01

    This study aims to explore families' reflections on their decision to donate brain tissue to the NSW Tissue Resource Centre (NSW TRC), Australia. Specifically, the study aims to investigate respondents' initial reactions to the request for donation, primary reasons for their decision, and subsequent satisfaction levels. Participants were next-of-kin (NOK) contacted between May 2002 and May 2008, on the day of their relative's autopsy, who agreed to donate brain tissue to the NSW TRC for medical research. All 111 NOK were invited to participate, and those who agreed completed an anonymous questionnaire. Fifty completed questionnaires were received. Results showed that 74% of respondents were not upset by the donation call and 98% were satisfied with their decision to donate. Of the 22% who reported having been upset, many indicated that their distress was partly related to their circumstances. When asked the main reason for their donation, 66% had wanted to help others, or help research, while 24% stated their primary reason as a belief that they were respecting the wishes of their deceased relative. These findings show that NOK are not further distressed by being asked to donate brain tissue, give altruistic reasons for consent and are satisfied with the decision they made. In both this study and previous literature, the importance of discussion about organ donation amongst relatives is a recurring theme. Knowledge about a relative's wishes is likely to help facilitate decision-making, overcoming at least one crucial barrier to lifting rates of organ donation for transplantation and research. PMID:21140229

  4. Real-time PCR detection of five different "endogenous control gene" transcripts in forensic autopsy material.

    Science.gov (United States)

    Heinrich, Marielle; Lutz-Bonengel, Sabine; Matt, Katja; Schmidt, Ulrike

    2007-06-01

    Relative quantification of mRNA using quantitative real-time reverse transcription (RT)-PCR is a commonly used method for analysis and comparison of gene expression levels. This method requires a normalisation of data against expression levels of a control gene. In the past, several ubiquitously expressed genes were used as such endogenous controls. When working with human tissue samples obtained during autopsy one has to deal with postmortem intervals of usually more than 10 h. The aim of this study was to investigate whether commonly used endogenous control genes show stability over various postmortem intervals. For this purpose, RNA was extracted from three different human tissues of five postmortem intervals ranging from 15 to 118 h. The Ct values from five commonly used endogenous control genes--beta-actin, B2M, CyPA, TBP, and UBC--were obtained by real-time RT-PCR. Results revealed a relatively high stability of Ct values in skeletal muscle tissue regarding different postmortem intervals. In heart and brain tissues, all endogenous controls were found to be highly variable. B2M appeared to be the least unstable control in this set. Nevertheless, all endogenous controls showed variability in their expression levels regarding both the stability among different tissues and different postmortem intervals. Data obtained in the present study show that postmortem mRNA degradation is a complex process, and that the use of one single endogenous control in gene expression studies of postmortem tissue would lead to erroneous data interpretation. Further studies on this topic should be performed in the future including an increased number of well documented samples. PMID:19083749

  5. Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool

    Science.gov (United States)

    Byass, Peter; Chandramohan, Daniel; Clark, Samuel J.; D'Ambruoso, Lucia; Fottrell, Edward; Graham, Wendy J.; Herbst, Abraham J.; Hodgson, Abraham; Hounton, Sennen; Kahn, Kathleen; Krishnan, Anand; Leitao, Jordana; Odhiambo, Frank; Sankoh, Osman A.; Tollman, Stephen M.

    2012-01-01

    Background Verbal autopsy (VA) is the only available approach for determining the cause of many deaths, where routine certification is not in place. Therefore, it is important to use standards and methods for VA that maximise efficiency, consistency and comparability. The World Health Organization (WHO) has led the development of the 2012 WHO VA instrument as a new standard, intended both as a research tool and for routine registration of deaths. Objective A new public-domain probabilistic model for interpreting VA data, InterVA-4, is described, which builds on previous versions and is aligned with the 2012 WHO VA instrument. Design The new model has been designed to use the VA input indicators defined in the 2012 WHO VA instrument and to deliver causes of death compatible with the International Classification of Diseases version 10 (ICD-10) categorised into 62 groups as defined in the 2012 WHO VA instrument. In addition, known shortcomings of previous InterVA models have been addressed in this revision, as well as integrating other work on maternal and perinatal deaths. Results The InterVA-4 model is presented here to facilitate its widespread use and to enable further field evaluation to take place. Results from a demonstration dataset from Agincourt, South Africa, show continuity of interpretation between InterVA-3 and InterVA-4, as well as differences reflecting specific issues addressed in the design and development of InterVA-4. Conclusions InterVA-4 is made freely available as a new standard model for interpreting VA data into causes of death. It can be used for determining cause of death both in research settings and for routine registration. Further validation opportunities will be explored. These developments in cause of death registration are likely to substantially increase the global coverage of cause-specific mortality data. PMID:22944365

  6. Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring

    Science.gov (United States)

    Leitao, Jordana; Chandramohan, Daniel; Byass, Peter; Jakob, Robert; Bundhamcharoen, Kanitta; Choprapawon, Chanpen; de Savigny, Don; Fottrell, Edward; França, Elizabeth; Frøen, Frederik; Gewaifel, Gihan; Hodgson, Abraham; Hounton, Sennen; Kahn, Kathleen; Krishnan, Anand; Kumar, Vishwajeet; Masanja, Honorati; Nichols, Erin; Notzon, Francis; Rasooly, Mohammad Hafiz; Sankoh, Osman; Spiegel, Paul; AbouZahr, Carla; Amexo, Marc; Kebede, Derege; Alley, William Soumbey; Marinho, Fatima; Ali, Mohamed; Loyola, Enrique; Chikersal, Jyotsna; Gao, Jun; Annunziata, Giuseppe; Bahl, Rajiv; Bartolomeus, Kidist; Boerma, Ties; Ustun, Bedirhan; Chou, Doris; Muhe, Lulu; Mathai, Matthews

    2013-01-01

    Objective Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. Methods A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. Findings A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. Conclusions The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians. PMID:24041439

  7. Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring

    Directory of Open Access Journals (Sweden)

    Jordana Leitao

    2013-09-01

    Full Text Available Objective: Verbal autopsy (VA is a systematic approach for determining causes of death (CoD in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS systems. Methods: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC. In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10 CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. Findings: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. Conclusions: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.

  8. Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool

    Directory of Open Access Journals (Sweden)

    Peter Byass

    2012-09-01

    Full Text Available Background: Verbal autopsy (VA is the only available approach for determining the cause of many deaths, where routine certification is not in place. Therefore, it is important to use standards and methods for VA that maximise efficiency, consistency and comparability. The World Health Organization (WHO has led the development of the 2012 WHO VA instrument as a new standard, intended both as a research tool and for routine registration of deaths. Objective: A new public-domain probabilistic model for interpreting VA data, InterVA-4, is described, which builds on previous versions and is aligned with the 2012 WHO VA instrument. Design: The new model has been designed to use the VA input indicators defined in the 2012 WHO VA instrument and to deliver causes of death compatible with the International Classification of Diseases version 10 (ICD-10 categorised into 62 groups as defined in the 2012 WHO VA instrument. In addition, known shortcomings of previous InterVA models have been addressed in this revision, as well as integrating other work on maternal and perinatal deaths. Results: The InterVA-4 model is presented here to facilitate its widespread use and to enable further field evaluation to take place. Results from a demonstration dataset from Agincourt, South Africa, show continuity of interpretation between InterVA-3 and InterVA-4, as well as differences reflecting specific issues addressed in the design and development of InterVA-4. Conclusions: InterVA-4 is made freely available as a new standard model for interpreting VA data into causes of death. It can be used for determining cause of death both in research settings and for routine registration. Further validation opportunities will be explored. These developments in cause of death registration are likely to substantially increase the global coverage of cause-specific mortality data.

  9. Fatal alcohol intoxication in women: A forensic autopsy study from Slovakia

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    Straka Lubomir

    2011-12-01

    Full Text Available Abstract Background Plenty of information related to alcoholism can be found in the literature, however, the studies have mostly dealt with the predominance of male alcoholism and data related to addiction in women are desperately scarce and difficult to find. Basic demographic data focusing on the impact of acute alcohol intoxication on the circumstances of death and social behaviour in the alcohol addicted female population are needed especially in the prevention of alcohol related mortality. Methods A retrospective forensic autopsy study of all accidental deaths due to alcohol intoxication over a 12-year period was performed in order to evaluate the locations, circumstances, mechanisms and causes of death. Results A sample of 171 cases of intoxicated women who died due to blood alcohol concentration (BAC equal to or higher than 2 g/kg was selected. Among them 36.26% (62/171 of women died due to acute alcohol intoxication (AAI. We noted an increase in the number of deaths in women due to AAI from 2 in 1994 up to 5 in 2005 (an elevation of 150% between the years 1994-2005. The age structure of deaths in women due to BAC and AAI followed the Gaussian distribution with a dominant group of women aged 41-50 years (45.16% and 35.09% respectively. The most frequent place of death (98% among women intoxicated by alcohol was their own home. The study suggests a close connection between AAI and violence against women. Conclusions The increasing number of cases of death of women suffering from AAI has drawn attention to the serious problem of alcoholism in women in the Slovak Republic during the process of integration into "western" lifestyle and culture.

  10. Lymphotoxin-alpha polymorphisms and presence of cancer in 1,536 consecutive autopsy cases

    Directory of Open Access Journals (Sweden)

    Muramatsu Masaaki

    2008-08-01

    Full Text Available Abstract Background Lymphotoxin-alpha (LTA is a pro-inflammatory cytokine with anti-tumor activity. The objective of this study was to determine whether LTA polymorphisms influence the presence of cancer. Methods LTA polymorphisms C804A (rs1041981, T60N and T495C (rs2229094, C13R were determined in 1,536 consecutive autopsy cases and were registered in the Japanese single-nucleotide polymorphisms (SNPs for geriatric research (JG-SNP Internet database. Tumors were systematically reviewed, pathologically confirmed, and assessed in relation to LTA genotype. Results The study population consisted of 827 males and 709 females, with a mean age of 80 years. Altogether, we studied 606 subjects without cancer and 930 subjects with cancer of the stomach (n = 183, lung (n = 164, colon or rectum (n = 143, or other sites. The presence of cancer was higher in males than in females. The C804A and T495C polymorphisms were associated with cancer in males (CA + AA: CC, adjusted OR = 0.72, 95% CI = 0.53 – 0.99; TC + CC: TT, adjusted OR = 1.45, 95% CI = 1.04 – 2.02; respectively but not in females. In males, the C804A polymorphism was associated with lung cancer (CA + AA: CC, adjusted OR = 0.60, 95% CI = 0.37 – 0.97, whereas the T495C polymorphism was associated with gastric cancer (TC + CC: TT, adjusted OR = 1.68, 95% CI = 1.06 – 2.65. Conclusion We found some evidence of an association between LTA polymorphisms and cancer risk in elderly Japanese men. Further studies in larger populations should examine this hypothesis.

  11. Plaque in superficial femoral arteries indicates generalized atherosclerosis and vulnerability to coronary death : an autopsy study

    DEFF Research Database (Denmark)

    Dalager, SØren; Falk, Erling

    2008-01-01

    OBJECTIVES: Risk factors for atherosclerosis have limited ability to identify persons at high risk of coronary heart disease. Assessment of subclinical atherosclerosis in peripheral arteries might improve this limitation. We studied the relationship between atherosclerotic plaques in peripheral arteries, coronary plaques, and coronary death. METHODS: Predefined segments from the left anterior descending coronary artery, the right coronary artery, bilateral carotid, and superficial femoral arteries (SFA) were obtained from 100 autopsies (20-82 years, 30 females, 27 coronary deaths). Based on microscopic examination of 4756 sections, the extension of atherosclerosis (plaque burden) and the largest plaque area in each segment were quantified. RESULTS: Plaque burden in all arteries increased with age and was larger in coronary death (P < .05). SFA plaques occurred later than coronary and carotid plaques. When SFA plaque had developed, coronary plaque was also present. SFA plaque (odds ratio, 95% confidence interval: 7.07 [2.40-20.81]), but not carotid plaque, was significantly associated with coronary death, also after age and gender adjustment (21.25 [5.02-89.97]). The area under the receiver operating characteristic curves for the identification of coronary death individuals was 0.72 (95% confidence interval: 0.62-0.83) for coronary plaque, and 0.80 (0.72-0.89) for SFA plaque (age and gender adjusted). CONCLUSIONS: Atherosclerosis develops slower in SFA compared with coronary and carotid arteries. In persons with plaque in the SFA, plaque is always present in the coronary arteries. In younger persons, the presence of SFA plaque indicates a generalized susceptibility to atherosclerosis and vulnerability to coronary death.

  12. Tuberculosis and tuberculosis/HIV/AIDS-associated mortality in Africa: the urgent need to expand and invest in routine and research autopsies.

    Science.gov (United States)

    Mudenda, Victor; Lucas, Sebastian; Shibemba, Aaron; O'Grady, Justin; Bates, Matthew; Kapata, Nathan; Schwank, Samana; Mwaba, Peter; Atun, Rifat; Hoelscher, Michael; Maeurer, Markus; Zumla, Alimuddin

    2012-05-15

    Frequently quoted statistics that tuberculosis and human immunodeficiency virus (HIV)/AIDS are the most important infectious causes of death in high-burden countries are based on clinical records, death certificates, and verbal autopsy studies. Causes of death ascertained through these methods are known to be grossly inaccurate. Most data from Africa on mortality and causes of death currently used by international agencies have come from verbal autopsy studies, which only provide inaccurate estimates of causes of death. Autopsy rates in most sub-Saharan African countries have declined over the years, and actual causes of deaths in the community and in hospitals in most sub-Saharan African countries remain unknown. The quality of cause-specific mortality statistics remains poor. The effect of various interventions to reduce mortality rates can only be evaluated accurately if cause-specific mortality data are available. Autopsy studies could have particular relevance to direct public health interventions, such as vaccination programs or preventive therapy, and could also allow for study of background levels of subclinical tuberculosis disease, Mycobacterium tuberculosis-HIV coinfection, and other infectious and noncommunicable diseases not yet clinically manifest. Autopsies performed soon after death may represent a unique opportunity to understand the pathogenesis of M. tuberculosis and the pathogenesis of early deaths after initiation of antiretroviral therapy. The few autopsies performed so far for research purposes have yielded invaluable information and insights into tuberculosis, HIV/AIDS, and other opportunistic infections. Accurate cause-specific mortality data are essential for prioritization of governmental and donor investments into health services to reduce morbidity and mortality from deadly infectious diseases such as tuberculosis and HIV/AIDS. There is an urgent need for reviving routine and research autopsies in sub-Saharan African countries. PMID:22448024

  13. Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study Alterações morfológicas no sistema digestivo de 93 pacientes infectados pelo vírus da imunodeficiência humana: um estudo de autopsias

    OpenAIRE

    Lucinda Calheiros Guimarães; Ana Cristina Araujo Lemos Silva; Adilha Misson Rua Micheletti; Everton Nunes Melo Moura; Mario Leon Silva-Vergara; Sheila Jorge Adad

    2012-01-01

    Involvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS) is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV) and the importance of these lesions to death. Of these, 90 (96.8%) patients ...

  14. Prevalence rate of thyroid diseases among autopsy cases of the atomic bomb survivors in Hiroshima, 1951-1985

    International Nuclear Information System (INIS)

    To examine the radiogenic risk of latent thyroid cancer, thyroid adenoma, colloid/adenomatous goiter and chronic thyroiditis, the date for 3821 subjects collected in the course of autopsies of atomic bomb survivors in Hiroshima from 1951 to 1985 by the Radiation Effects Research Foundation (RERF) were analyzed using a logistic model. About 80% of the autopsies were performed at RERF and the remainder at local hospitals. The frequencies of the above diseases were not associated with whether the underlying cause of death was cancer. However, note that our results may be influenced by potentially biasing factors associated with autopsy selection. The relative frequency of latent thyroid cancer (greatest dimension ?1.5 cm but detectable on a routine microscopic slide of the thyroid gland) increased as the radiation dose increased and was about 1.4-fold greater at 1 Gy than in the 0-Gy dose group. The relative occurrence of thyroid adenoma also increased as radiation dose increased, and was about 1.5-fold greater at 1 Gy than in the 0-Gy dose group. Sex, age at the time of the bombing or period of observation did not significantly modify the radiogenic risks for thyroid adenoma or latent thyroid cancer. No statistically significant association was found between radiation exposure and the rates of colloid/adenomatous goiter and chronic thyroiditis. The possible late effect of atomic bomb radiation on the frequency of benign thyroid diseases is discussed on the basis of thdiseases is discussed on the basis of these data. 38 refs., 2 figs., 5 tabs

  15. Demographic, etiological, and histological pulmonary analysis of patients with acute respiratory failure: a study of 19 years of autopsies

    Scientific Electronic Library Online (English)

    Alexandre de Matos, Soeiro; Aline D., Ruppert; Mauro, Canzian; Edwin R., Parra; Cecília, Farhat; Vera L., Capelozzi.

    1193-11-01

    Full Text Available INTRODUCTION: Acute respiratory failure has been one of the most important causes of death in intensive care units, and certain aspects of its pulmonary pathology are currently unknown. OBJECTIVES: The objective was to describe the demographic data, etiology, and pulmonary histopathological findings [...] of different diseases in the autopsies of patients with acute respiratory failure. METHOD: Autopsies of 4,710 patients with acute respiratory failure from 1990 to 2008 were reviewed, and the following data were obtained: age, sex, and major associated diseases. The pulmonary histopathology was categorized as diffuse alveolar damage, pulmonary edema, alveolar hemorrhage, and lymphoplasmacytic interstitial pneumonia. The odds ratio of the concordance between the major associated diseases and specific autopsy findings was calculated using logistic regression. RESULTS: Bacterial bronchopneumonia was present in 33.9% of the cases and cancer in 28.1%. The pulmonary histopathology showed diffuse alveolar damage in 40.7% (1,917) of the cases. A multivariate analysis showed a significant and powerful association between diffuse alveolar damage and bronchopneumonia, HIV/AIDS, sepsis, and septic shock, between liver cirrhosis and pulmonary embolism, between pulmonary edema and acute myocardial infarction, between dilated cardiomyopathy and cancer, between alveolar hemorrhage and bronchopneumonia and pulmonary embolism, and between lymphoplasmacytic interstitial pneumonia and HIV/ AIDS and liver cirrhosis. CONCLUSIONS: Bronchopneumonia was the most common diagnosis in these cases. The most prevalent pulmonary histopathological pattern was diffuse alveolar damage, which was associated with different inflammatory conditions. Further studies are necessary to elucidate the complete pathophysiological mechanisms involved with each disease and the development of acute respiratory failure.

  16. Functional integrity of mitochondrial genomes in human platelets and autopsied brain tissues from elderly patients with Alzheimer’s disease

    OpenAIRE

    Ito, Sayaka; Ohta, Shigeo; Nishimaki, Kiyomi; Kagawa, Yasuo; Soma, Rika; Kuno, Shin-ya; Komatsuzaki, Yasuko; Mizusawa, Hidehiro; Hayashi, Jun-ichi

    1999-01-01

    To determine whether pathogenic mutations in mtDNA are involved in phenotypic expression of Alzheimer’s disease (AD), the transfer of mtDNA from elderly patients with AD into mtDNA-less (?0) HeLa cells was carried out by fusion of platelets or synaptosomal fractions of autopsied brain tissues with ?0 HeLa cells. The results showed that mtDNA in postmortem brain tissue survives for a long time without degradation and could be rescued in ?0 HeLa cells. Next, the cybrid clones repopulated w...

  17. Association of diabetes mellitus with coronary atherosclerosis and myocardial lesions. An autopsy study from the Honolulu Heart Program.

    Science.gov (United States)

    Burchfiel, C M; Reed, D M; Marcus, E B; Strong, J P; Hayashi, T

    1993-06-15

    While the excess risk of clinical cardiovascular disease among persons with diabetes mellitus is well established, most autopsy studies have not been able to elucidate reasons for the excess, to assess potential selection bias, or to adjust for other cardiovascular risk factors. The purpose of this study was to examine the predictive relation between diabetes and autopsy evidence of coronary atherosclerosis and myocardial lesions. Among 8,006 Japanese-American men examined at baseline in 1965-1968 as part of the Honolulu Heart Program, 7,591 were free of cardiovascular disease, and 1,515 of these men died over a 17-year follow-up period. Protocol autopsies were performed for 83 diabetic men and 159 nondiabetic men. Diabetes status was defined using self-reported history and treatment at several examinations, as well as physician diagnoses during hospitalization between 1965 and 1984. An excess of coronary artery atherosclerosis, assessed by mean panel score (3.4 vs. 3.0, p = 0.017) and percentage of intimal surface with raised lesions (56.6% vs. 47.4%, p = 0.024), was present among diabetic men but diminished to nonsignificant levels (3.3 vs. 3.0, p = 0.102, and 53.9% vs. 48.8%, p = 0.183, respectively) after adjustment for other cardiovascular risk factors. Myocardial lesions (acute, healing, or fibrotic) occurred significantly more frequently among diabetics than among nondiabetics (77.7% vs. 63.4%, p = 0.035), even after adjustment for other risk factors. Potential autopsy selection bias assessed in several ways appeared minimal. Among men with mild atherosclerosis, diabetics had more small and large myocardial lesions than did nondiabetics, although differences were not statistically significant (p < 0.10). It appears that the more adverse risk factor profile among diabetics accounts for some of the observed excess of coronary atherosclerosis. However, diabetes was independently associated with myocardial lesions, and these findings suggest a role for nonatherosclerotic mechanisms, such as clotting abnormalities or microvascular disease, in accounting for the excess clinical heart disease found in persons with diabetes. PMID:8333414

  18. The unexpected finding of a benign mature teratoma in a forensic pathology autopsy : a rare cause for sudden, unexpected death

    DEFF Research Database (Denmark)

    HØyer, Christian Bjerre; UlhØi, Benedicte Parm

    2013-01-01

    Intracranial teratomas are rare tumors that are usually discovered in infancy due to progressive symptoms. We describe a case of a 38-year-old man who was found dead 9 hours after the last sign of life. The deceased's medical history could not explain the sudden, unexpected death. A forensic autopsy revealed an asymptomatic, mature teratoma in the left frontal and temporal lobes. We concluded that the cause of death must have been a generalized epileptiform seizure originating in the tumor site(s) leading to aspiration of the stomach contents and unfavorable positioning, resulting in asphyxia.

  19. An autopsy case of atypical acute myelogenous leukemia with 8 trisomy in an atomic bomb survivor (early entry)

    International Nuclear Information System (INIS)

    Clinical course and autopsy findings of an 80-year-old male, an atomic bomb survivor, with 8 trisomy were reported. The patient's disease was in the category of atypical acute myelogenous leukemia, smoldering acute leukemia, or hemopoietic dysplasis. An abnormal nucleus type of 47, XY, and +8 was found in all bone marrow cells examined. However, there was no evidence that this patient had exposed to high radioactivity due to a-bomb, no that the disease was induced by radiation exposure. Though the activity of glutathione was not high in this case, the relation between the glutathione activity and 8 trisomy should be further investigated. (Nakanishi, T.)

  20. Mercury in human brain, blood, muscle and toenails in relation to exposure: an autopsy study

    Directory of Open Access Journals (Sweden)

    Morild Inge

    2007-10-01

    Full Text Available Abstract Background The main forms of mercury (Hg exposure in the general population are methylmercury (MeHg from seafood, inorganic mercury (I-Hg from food, and mercury vapor (Hg0 from dental amalgam restorations. While the distribution of MeHg in the body is described by a one compartment model, the distribution of I-Hg after exposure to elemental mercury is more complex, and there is no biomarker for I-Hg in the brain. The aim of this study was to elucidate the relationships between on the one hand MeHg and I-Hg in human brain and other tissues, including blood, and on the other Hg exposure via dental amalgam in a fish-eating population. In addition, the use of blood and toenails as biological indicator media for inorganic and organic mercury (MeHg in the tissues was evaluated. Methods Samples of blood, brain (occipital lobe cortex, pituitary, thyroid, abdominal muscle and toenails were collected at autopsy of 30 deceased individuals, age from 47 to 91 years of age. Concentrations of total-Hg and I-Hg in blood and brain cortex were determined by cold vapor atomic fluorescence spectrometry and total-Hg in other tissues by sector field inductively coupled plasma-mass spectrometry (ICP-SFMS. Results The median concentrations of MeHg (total-Hg minus I-Hg and I-Hg in blood were 2.2 and 1.0 ?g/L, and in occipital lobe cortex 4 and 5 ?g/kg, respectively. There was a significant correlation between MeHg in blood and occipital cortex. Also, total-Hg in toenails correlated with MeHg in both blood and occipital lobe. I-Hg in both blood and occipital cortex, as well as total-Hg in pituitary and thyroid were strongly associated with the number of dental amalgam surfaces at the time of death. Conclusion In a fish-eating population, intake of MeHg via the diet has a marked impact on the MeHg concentration in the brain, while exposure to dental amalgam restorations increases the I-Hg concentrations in the brain. Discrimination between mercury species is necessary to evaluate the impact on Hg in the brain of various sources of exposure, in particular, dental amalgam exposure.

  1. Cultural imperatives and the ethics of verbal autopsies in rural Ghana

    Directory of Open Access Journals (Sweden)

    Raymond A. Aborigo

    2013-09-01

    Full Text Available Background: Due to a paucity of statistics from vital registration systems in developing countries, the verbal autopsy (VA approach has been used to obtain cause-specific mortality data by interviewing lay respondents on the signs and symptoms experienced by the deceased prior to death. In societies where the culture of mourning is adhered to, the use of VA could clash with traditional norms, thus warranting ethical consideration by researchers. Objective: The study was designed to explore the ethics and cultural context of collecting VA information through a demographic and health surveillance system in the Kassena-Nankana District (KND of Ghana. Study Design: Data were collected through qualitative in-depth interviews (IDIs with four field staff involved in the routine conduct of VAs, four physicians who code VAs, 20 selected respondents to the VA tool, and eight opinion leaders in the KND. The interviews were supplemented with observation by the researchers and with the field notes of field workers. Interviews were audio-recorded, and local language versions transcribed into English. Thematic analysis was performed using QSR NVivo 8 software. Results: The data indicate that cultural sensitivities in VA procedures at both the individual and family levels need greater consideration not only for ethical reasons but also to ensure the quality of the data. Discussions of some deaths are culturally prohibited and therefore lead to refusal of interviews. Families were also concerned about the confidentiality of information because of the potential of blame for the death. VA teams do not necessarily engage in culturally appropriate bereavement practices such as the presentation of tokens. The desire by families for feedback on the cause of death, which is currently not provided by researchers, was frequently expressed. Finally, no standard exists on the culturally acceptable time interval between death and VA interviews. Conclusion: Ethical issues need to be given greater consideration in the collection of cause of death data, and this can be achieved through the establishment of processes that allow active engagement with communities, authorities of civil registrations, and Institutional Review Boards to take greater account of local contexts.

  2. Medición del panículo adiposo abdominal en autopsias / Measument of the panniculus adiposus abdominis in autopsies

    Scientific Electronic Library Online (English)

    José, Hurtado de Mendoza Amat; Teresita de J, Montero González; Justo, Hurtado de Mendoza Amat.

    2014-09-01

    Full Text Available Objetivo: evaluar la relación de la medida del panículo adiposo abdominal con la edad y el sexo, los parámetros hospitalarios, las causas de muerte y otras enfermedades diagnosticadas. Métodos: se procesaron por el Sistema Automatizado de Registro y Control de Anatomía Patológica 591 autopsias, en l [...] as que se midió el panículo adiposo abdominal a nivel del ombligo. Se crearon tres grupos de estudio según el grosor, con un número similar de casos: 0,1-1,6 cm; 1,7-2,6 cm y 2,7-9,2 cm. Resultados: en el grupo de mayor grosor el promedio de edad fue de 65 años; el 33,3 % correspondió al sexo masculino y el 62,6 % al femenino. Entre las causas de muerte aumentó el infarto agudo del miocardio y disminuyó la enfermedad cerebrovascular. Los tumores malignos se incrementaron en correspondencia con el aumento del grosor del panículo adiposo. Como causas contribuyentes se encontraron la elevación de la hipertensión arterial y la diabetes mellitus. En los trastornos relacionados con el síndrome metabólico, los órganos más afectados fueron las arterias, el páncreas, el hígado, el corazón y la vesícula biliar. Conclusiones: el grosor del panículo adiposo abdominal resulta un indicador apropiado para precisar la grasa abdominal y su importancia; así como su relación con la edad y el sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, principalmente aquellas que forman parte del síndrome metabólico. Abstract in english Objective: to evaluate the relationship among the size of panniculus adiposus abdominis , age, sex, hospital parameters, causes of death and other diagnosed diseases Methods: using the automated system of registry and control of pathological anatomy, 591 autopsies were processed in which the abdomin [...] al fatty panniculus adiposus abdominis around the navel. Three study groups were created according to thickness, with a similar number of cases: 0.1-1.6 cm: 1.7-2.6 cm and 2.7-9.2 cm. Results: the average age in the group with the thickest panniculus adiposus abdominis was 65 years: 33.3 % in males and 62.6 % in females. Acute myocardial infarction increased whereas the cerebrovascular disease decreased. The number of malignant tumors increased as the panniculus adiposus thickness increases too. The contributing causes were high blood pressure and diabetes mellitus. Regarding the metabolic syndrome related disorders, the most affected organs were arteries, pancreas, liver, heart and gallbladder. Conclusions: the panniculus adiposus abdominis thickness is an adequate indicator to measure abdominal adiposity and its importance, as well as its relationship with age and sex, hospital parameters, causes of death and other diagnosed diseases, mainly those related to the metabolic syndrome.

  3. [The analysis of neonatal deaths based on autopsy protocols of the Department of Forensic Medicine in Bialystok in the years 1955-2009].

    Science.gov (United States)

    Ptaszy?ska-Sarosiek, Iwona; Niemcunowicz-Janica, Anna; Filimoniuk, Marcin; Ok?ota, Magdalena; Wardaszka, Zofia; Szeremeta, Micha?; Sackiewicz, Adam

    2011-01-01

    The authors performed an analysis of the causes of deaths of newborns with special emphasis placed on cases when neonaticide was suspected. In the discussed period, 17838 medico-legal autopsies were performed, 124 of them (0.695 per cent of all postmortem examinations) involved children who meet the WHO criteria for newborn - children under 28th day of life. The newborns were divided into two groups according to their exact age at the time of death - newborns who died within a short time after birth and newborns who died after the perinatal period. Their sex, body length and body weight were also taken into consideration. A total of 108 autopsies (87.1 per cent of all autopsied newborns) involved cases of suspected criminal infanticide within the first score of hours postnatally. In the majority of these cases, the cause of death was suffocation, rarely mechanical trauma. The case of death of older newborns was broadly understood trauma. PMID:22715681

  4. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

    International Nuclear Information System (INIS)

    To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT). PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death. (orig.)

  5. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

    Energy Technology Data Exchange (ETDEWEB)

    Winklhofer, Sebastian; Stolzmann, Paul [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Surer, Eddie; Ampanozi, Garyfalia; Thali, Michael; Schweitzer, Wolf [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Ruder, Thomas [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); University Hospital Bern, Institute of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Elliott, Marina [Simon Fraser University, Department of Archaeology, Burnaby, BC (Canada); Oestreich, Andrea; Kraemer, Thomas [University of Zurich, Department of Forensic Pharmacology and Toxicology, Institute of Forensic Medicine, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)

    2014-06-15

    To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT). PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death. (orig.)

  6. Identification of Novel Missense Mutations of Cardiac Ryanodine Receptor Gene in Exercise-Induced Sudden Death at Autopsy

    Science.gov (United States)

    Creighton, Wendy; Virmani, Renu; Kutys, Robert; Burke, Allen

    2006-01-01

    Mutations in the cardiac ryanodine type 2 receptor (RyR2) gene are associated with catecholaminergic polymorphic ventricular tachycardia. We hypothesized that these mutations could be detected at autopsy in cases of exercise-triggered sudden death. Fourteen sudden death patients, eight males and six females, were studied at autopsy based on apparent sudden cardiac death, without significant anatomical abnormalities. The coding regions of arrhythmia genes were amplified by polymerase chain reaction and directly sequenced. Three novel RyR2 mutations, R414C, F2331S, and R2401L, were identified in three unrelated patients (two males and one female; mean age at death, 12 ± 2 years), all performing strenuous activity at the time of death or collapse. These mutations were located in highly conserved regions where arrhythmia-linked RyR2 mutations clustered. Although G269S in the KVLQT1 gene was detected in a female with known family history of syncope and sudden cardiac death, no other mutations were found in any of the 14 cases, and no other mutations was found in 200 controls. The absence of structural cardiac disease in physical activity-induced sudden death and the finding of three novel RyR2 mutations suggest that mutation screening in such cases should include RyR2. PMID:16436635

  7. Bronchopulmonary arterial anastomosis at the precapillary level in human lung. Visualization using CT angiography compared with microangiography of autopsied lung

    International Nuclear Information System (INIS)

    To investigate the interrelationships between the bronchial and pulmonary circulations including the existence of precapillary bronchopulmonary arterial anastomoses, CT of bronchial arteriography (BAG-CT) was performed in 10 patients and BAG-CT during a pulmonary artery block test (PA-block) in 5 patients with lung cancer. Bronchial and pulmonary circulations were evaluated in 5 autopsied normal lungs by injecting silicone rubber with different colors into the bronchial and pulmonary arteries. BAG-CT correlated well with the findings at silicone rubber injection into lung autopsy samples. BAG-CT demonstrated inflow of contrast medium into the pulmonary artery during PA-block in all cases, while no inflow was observed before and following reversal of PA-block. Mixed silicone rubber was observed in the lobar to subsubsegmental bronchial arteries in all cases and in the subsubsegmental pulmonary artery in one case. Precapillary bronchopulmonary arterial anastomoses may exist at the level of the lobar bronchi to the periphery. If either the pulmonary or bronchial circulation is disturbed, flow occurs inside the anastomoses to supplement the other flow, especially flow from the bronchial to the pulmonary arteries via the anastomoses, which occurs within 30 min

  8. Bronchopulmonary arterial anastomosis at the precapillary level in human lung. Visualization using CT angiography compared with microangiography of autopsied lung

    International Nuclear Information System (INIS)

    Purpose: To investigate the interrelationships between the bronchial and pulmonary circulations including the existence of precapillary bronchopulmonary arterial anastomoses. Material and Methods: CT of bronchial arteriography (BAG-CT) was performed in 10 patients and BAG-CT during a pulmonary artery block test (PA-block) in 5 patients with lung cancer. Bronchial and pulmonary circulations were evaluated in 5 autopsied normal lungs by injecting silicone rubber with different colors into the bronchial and pulmonary arteries. Results: BAG-CT correlated well with the findings at silicone rubber injection into lung autopsy samples. BAG-CT demonstrated inflow of contrast medium into the pulmonary artery during PA-block in all cases, while no inflow was observed before and following reversal of PA-block. Mixed silicone rubber was observed in the lobar to subsubsegmental bronchial arteries in all cases and in the subsubsegmental pulmonary artery in one case. Conclusion: Precapillary bronchopulmonary arterial anastomoses may exist at the level of the lobar bronchi to the periphery. If either the pulmonary or bronchial circulation is disturbed, flow occurs inside the anastomoses to supplement the other flow, especially flow from the bronchial to the pulmonary arteries via the anastomoses, which occurs within 30 min. (orig.)

  9. Forensic aspects of carbon monoxide poisoning by charcoal burning in Denmark, 2008-2012 : an autopsy based study

    DEFF Research Database (Denmark)

    Nielsen, Pia Rude; Gheorghe, Alexandra

    2014-01-01

    Carbon monoxide (CO) inhalation is a well-known method of committing suicide. There has been a drastic increase in suicide by inhalation of CO, produced from burning charcoal, in some parts of Asia, and a few studies have reported an increased number of these deaths in Europe. CO-related deaths caused by charcoal burning have, to our knowledge, not been recorded in the Danish population before. In this retrospective study we present all autopsied cases of CO poisoning caused by charcoal burning in the period 2008-2012. 19 autopsied cases were identified, comprising 11 suicides, 4 accidents, and 2 cases of maternal/paternal filicide-suicide. The mean age of decedents was 38.2 years and the majority of the decedents were men. In 16 cases carboxyhemoglobin levels were above 50 % and in 14 cases we found distinctive cherry red livor mortis. Various concentrations of ethanol and drugs were found in 9 cases. Data suggest that this method of death has increased significantly in Denmark. Therefore, it is highly relevant to draw attention to the subject, to increase awareness as well as prevent future escalation.

  10. A retrospective analysis of alcohol in medico-legal autopsied deaths in Pretoria over a 1 year period.

    Science.gov (United States)

    Ehmke, Ursula; Toit-Prinsloo, Lorraine du; Saayman, Gert

    2014-10-15

    The misuse of alcohol has a particularly detrimental effect and is one of the most significant public health problems in South Africa and it also has an impact on the criminal justice system with evidence of association between high levels of alcohol and risk-taking behaviour, committing crimes, or being a victim of crime. A global trend has been set worldwide with alcohol being one of the most common drugs found in post mortem specimens and especially with regard to cases admitted for medico-legal autopsies. The influence of alcohol on the cause of death is either a contributory or an underlying factor in a substantial number of violent deaths. We retrospectively reviewed 1455 cases, in which alcohol was taken, of 2344 medico-legal autopsies done in 2009. We found that 47% of the cases tested positive for alcohol, with the reported blood alcohol concentrations varying from 0.01 to 0.95g per 100ml (mean=0.16±0.11g per 100ml) with the highest proportion being in the 0.10-0.19g per 100ml range. A breakdown of the results showed that road traffic accidents, assaults and firearm-related deaths predominated the alcohol-positive cases. The results showed that there was a definite correlation between alcohol consumption and the incidence of other that natural deaths. PMID:25447167

  11. An autopsy case of acute myelocytic leukemia preceded by hemopoietic dysplasia found in an atomic bomb survivor

    International Nuclear Information System (INIS)

    An autopsy case of acute myelocytic leukemia preceded by hemopoietic dysplasia, presumably on a sequela to the atomic bomb in Hiroshima is reported. On admission, severe anemia and thrombocytosis were found and the bone marrow aspiration showed myeloid hyperplasia without definite maturation arrest. Mild to moderate eosinophilia and basophilia continued during the course of the disease, accompaning mild monocytosis 2 years later. Furthermore, he had the radical operation for the early gastric cancer in this preleukemic stage. After the administration of methenolone acetate (25 mg/day), severe anemia has dramatically improved, but leukocytosis with profound monocytosis persisted, and subsequently acute myelocytic leukemia developed. He died from an intracerebral bleeding due to an accidental trauma on the head. Autopsy findings disclosed the systemic leukemic infiltration. Repeated chromosome analyses revealed the mosaic karyotype of 46, XY/45, XY, -16 on admission, but it was 46, XY/46, XY, del (8) (p 12) in the overt leukemic phase. The granulopoietic colony forming capacity of bone marrow cells was already low one year before the onset of overt leukemia. This finding suggested that the existence of an abnormal clone could be predictable. In addition, the possible causative effect of the exposure to the atomic bomb in leukemogenesis in this case is discussed. (author)

  12. Histopatología del daño múltiple de órganos en autopsias pediátricas / Histopathology of multiple organ damage in paediatric autopsies

    Scientific Electronic Library Online (English)

    Teresita, Montero González; Yanira Noalis, Díaz Valdés; José, Hurtado de Mendoza Amat; Cecilia, Toledo Veja; Arturo, Delgado Delgado; Sonia, Pujol Olivares.

    2013-06-01

    Full Text Available Introducción: el daño múltiple de órganos es el conjunto de alteraciones morfológicas, frecuentes en pacientes críticos, diagnosticadas en las autopsias como respuesta a la inflamación sistémica. En estudios realizados, las personas con edades jóvenes de la vida se han visto particularmente afectada [...] s por esta entidad. Objetivo: analizar el comportamiento del diagnóstico del daño múltiple de órganos en autopsias pediátricas procedentes de dos unidades de terapia intensiva e identificar las manifestaciones histopatológicas, la edad y el sexo de los niños fallecidos. Métodos: se revisaron 13 autopsias de niños fallecidos en el Hospital Militar Central "Dr. Luis Díaz Soto" en 5 años (2003-2007) y 42 correspondientes al Hospital Pediátrico Docente de San Miguel del Padrón en un periodo de 7 años (2000-2006), y se extrajeron las que cumplieron los criterios diagnósticos del daño múltiple de órganos. Resultados: se destacó la elevada frecuencia del daño múltiple de órganos en las autopsias de la terapia pediátrica en ambos centros estudiados. Los primeros periodos de vida fueron los más afectados, mientras el sexo mostró variaciones entre ambos centros estudiados. Conclusiones: el diagnóstico del daño múltiple de órganos es expresión de la calidad del trabajo que se realiza con las autopsias y la preparación del personal médico, lo cual se muestra en las elevadas cifras de coincidencias diagnósticas. Modular la respuesta inflamatoria incontrolada, es prevenir que se establezca el referido daño y, por lo tanto, es salvar la vida de un niño. Abstract in english Introduction: multiple organ damage is a group of morphological alterations, frequent in critical patients, which are diagnosed in autopsies as a response to systemic inflammation. Different studies report that the youngest people have been particularly affected by this disease. Objective: to analyz [...] e the behaviour of the diagnosis of multiple organ damage in paediatric autopsies from two Intensive Care Units and identify the histopathological manifestations, the age, and the sex in dead children. Methods: 13 autopsies of dead children were checked in "Dr. Luis Diaz Soto" Central Military Hospital during 5 years (2003-2007). Other 42 corresponding to the Paediatric Teaching Hospital of San Miguel del Padrón were also checked over a period of 7 years (2000-2006). The ones that reported diagnostic criteria of multiple organ damage were selected. Results: a high frequency of multiple organ damage in autopsies of paediatric therapies in both cases under study was emphasized. The first periods of life were the most affected ones and the sex showed some variations in the two centres under study. Conclusions: the diagnosis of multiple organ damage is the reflection of both the quality of work carried out with autopsies and the training of the medical staff. It is shown in the high levels of diagnostic coincidences. To regulate the uncontrolled inflammatory response means preventing the referred damage, thus saving a child's life.

  13. Verbal autopsy coding: are multiple coders better than one? / Codage des autopsies verbales: est-il préférable qu'il soit effectué par plusieurs codeurs au lieu d'un ? / Codificación de las autopsias verbales: ¿varios codificadores mejor que uno?

    Scientific Electronic Library Online (English)

    Rohina, Joshi; Alan D, Lopez; Stephen, MacMahon; Srinath, Reddy; Rakhi, Dandona; Lalit, Dandona; Bruce, Neal.

    2009-01-01

    Full Text Available OBJETIVO: Evaluar el impacto en los perfiles de causas de defunción notificadas de una estrategia de codificación de las autopsias verbales basada en el uso de uno o varios agentes codificadores para examinar cada caso de defunción. MÉTODOS: A lo largo de 12 meses durante 2003-2004 se documentaron l [...] as defunciones registradas en 45 aldeas (población total: 180 162 habitantes) del sur de la India, rellenándose para cada fallecimiento un cuestionario de autopsia verbal estándar. Dos codificadores médicos, sin conocer cada uno las decisiones del otro, asignaron las causas de defunción basándose en las causas enumeradas en los títulos de los capítulos de la décima revisión de la Clasificación Internacional de Enfermedades y Problemas de Salud Conexos (CIE-10). Para los tres títulos de capítulos que se aplicaron a más de 100 defunciones, se analizó también el grado de coincidencia para subconjuntos de causas de defunción dentro del capítulo. En caso de discrepancia, un tercer codificador intervenía para dirimirla. La medición del grado de acuerdo entre los dos codificadores médicos se realizó mediante el estadístico kappa de Cohen (K). RESULTADOS: En total se documentaron 1354 defunciones, realizándose una autopsia verbal en 1329 (98%) de ellas. En lo que respecta a los títulos de los capítulos de la CIE-10, los codificadores médicos asignaron la misma causa a 1255 defunciones (94%) (K = 0,93; intervalo de confianza del 95%: 0,92-0,94). Los perfiles de mortalidad derivados de las causas asignadas por cada médico fueron muy similares a los perfiles obtenidos mediante el proceso de consenso, hasta el punto de que el orden de importancia de las 10 causas principales de defunción fue el mismo con los tres métodos de codificación. CONCLUSIÓNS: La duplicación de la codificación de los resultados de las autopsias verbales no ofrece grandes ventajas respecto al sistema de codificador único en el contexto de la vigilancia de la mortalidad o la identificación de perfiles demográficos de la mortalidad. Se podrían desviar recursos hacia otros aspectos del proceso de vigilancia de la mortalidad, como por ejemplo la validación. Abstract in english OBJECTIVE: To assess the impact on the reported cause-of-death patterns of a verbal autopsy coding strategy based on a review of every death by multiple coders versus a single coder. METHODS: Deaths in 45 villages (total population 180 162) in southern India were documented during 12 months in 2003- [...] 2004, and a standard verbal autopsy questionnaire was completed for each death. Two physician coders, each unaware of the other's decisions, assigned an underlying cause of death in accordance with the causes listed in the chapter headings of the International classification of diseases and related health problems, 10th revision (ICD-10). For the three chapter headings that applied to more than 100 of the deaths, agreement for subsets of causes of death within the chapter was also analysed. In the event of discrepancies, a third coder was used to finalize a cause of death. Cohen's kappa statistic (K) was used to measure levels of agreement between the two physician coders. FINDINGS: In total, 1354 deaths were documented, and a verbal autopsy was completed for 1329 (98%) of them. At the chapter heading level of the ICD-10, physician coders assigned the same cause to 1255 deaths (94%) (K = 0.93; 95% confidence interval: 0.92-0.94). The patterns of death derived from the causes assigned by each physician were all very similar to the patterns obtained through the consensus process, with the rank order of the 10 leading causes of death being the same for all three coding methods. CONCLUSION: Duplicate coding of verbal autopsy results has little advantage over a single-coder system for mortality surveillance or for identifying population patterns of death. Resources could be better diverted to other parts of the mortality surveillance process, such as validation.

  14. Interobserver agreement of the injury diagnoses obtained by postmortem computed tomography of traffic fatality victims and a comparison with autopsy results

    DEFF Research Database (Denmark)

    Leth, Peter Mygind; Struckmann, Henrik

    2013-01-01

    The present study investigated the interobserver variation between a radiologist and a forensic pathologist in 994 injury diagnoses obtained by postmortem computed tomography (CT) of 67 traffic fatality victims, and the results were compared with diagnoses obtained by autopsy. The injuries were coded according to the abbreviated injury scale (AIS). We found a low interobserver variability for postmortem CT injury diagnoses, and the variability was the lowest for injuries with a high AIS severity score. The radiologist diagnosed more injuries than the pathologist, especially in the skeletal system, but the pathologist diagnosed more organ injuries. We recommend the use of a radiologist as a consultant for the evaluation of postmortem CT images. Training in radiology should be included in forensic medicine postgraduate training. CT was superior to autopsy in detecting abnormal air accumulations, but autopsy was superior to CT in the detection of organ injuries and aortic ruptures. We recommend a combination of CT and autopsy for the postmortem investigation of traffic fatality victims.

  15. A state-of-the-art pipeline for postmortem CT and MRI visualization: from data acquisition to interactive image interpretation at autopsy

    Energy Technology Data Exchange (ETDEWEB)

    Persson, Anders (Center for Medical Image Science and Visualization (CMIV), Univ. of Linkoeping, Linkoeping (Sweden); Dept. of Radiology of Medical and Health Sciences (IMH), Linkoeping Univ. Hospital, Linkoeping (Sweden)), email: anders.persson@cmiv.liu.se; Lindblom, Maria (Dept. of Radiology of Medical and Health Sciences (IMH), Linkoeping Univ. Hospital, Linkoeping (Sweden)); Jackowski, Christian (Inst. of Legal Medicine, Univ. of Zurich, Zurich (Switzerland))

    2011-06-15

    The importance of autopsy procedures leading to the establishment of the cause of death is well-known. A recent addition to the autopsy work flow is the possibility of conducting postmortem imaging, in its 3D version also called virtual autopsy (VA), using multidetector computed tomography (MDCT) or magnetic resonance imagining (MRI) data from scans of cadavers displayed with direct volume rendering (DVR) 3D techniques. The use of the data and their workflow are presented. Data acquisition was performed and high quality data-sets with submillimeter precision were acquired. New data acquisition techniques such as dual-energy CT (DECT) and quantitative MRI, then were implemented and provided additional information. Particular findings hardly visualized in conventional autopsy can rather easy be seen at the full body CT, such as air distribution, e.g. pneumothorax, pneumopericardium, air embolism, and wound channels. MRI shows natural deaths such as myocardial infarctions. Interactive visualization of these 3D data-sets can provide valuable insight into the corpses and enables non-invasive diagnostic procedures. In postmortem CT imaging, not being limited by a patient depending radiation dose limit the data-sets can, however, be generated with such a high resolution that they become difficult to handle in today's archive retrieval and interactive visualization systems, specifically in the case of full body scans. To take full advantage of these new technologies the postmortem workflow needs to be tailored to the demands and opportunities that the new technologies allow

  16. A state-of-the-art pipeline for postmortem CT and MRI visualization: from data acquisition to interactive image interpretation at autopsy

    International Nuclear Information System (INIS)

    The importance of autopsy procedures leading to the establishment of the cause of death is well-known. A recent addition to the autopsy work flow is the possibility of conducting postmortem imaging, in its 3D version also called virtual autopsy (VA), using multidetector computed tomography (MDCT) or magnetic resonance imagining (MRI) data from scans of cadavers displayed with direct volume rendering (DVR) 3D techniques. The use of the data and their workflow are presented. Data acquisition was performed and high quality data-sets with submillimeter precision were acquired. New data acquisition techniques such as dual-energy CT (DECT) and quantitative MRI, then were implemented and provided additional information. Particular findings hardly visualized in conventional autopsy can rather easy be seen at the full body CT, such as air distribution, e.g. pneumothorax, pneumopericardium, air embolism, and wound channels. MRI shows natural deaths such as myocardial infarctions. Interactive visualization of these 3D data-sets can provide valuable insight into the corpses and enables non-invasive diagnostic procedures. In postmortem CT imaging, not being limited by a patient depending radiation dose limit the data-sets can, however, be generated with such a high resolution that they become difficult to handle in today's archive retrieval and interactive visualization systems, specifically in the case of full body scans. To take full advantage of these new technologies the postmantage of these new technologies the postmortem workflow needs to be tailored to the demands and opportunities that the new technologies allow

  17. Virtual autopsy in forensic sciences and its applications in the forensic odontology / A autópsia virtual nas ciências forenses e sua aplicação na Odontologia forense

    Scientific Electronic Library Online (English)

    Ademir Franco do, Rosário Junior; Paulo Henrique Couto, Souza; Walter, Coudyzer; Patrick, Thevissen; Guy, Willems; Reinhilde, Jacobs.

    Full Text Available Atualmente os avanços tecnológicos se fazem cada vez mais importantes nas ciências forenses. Por outro lado a autópsia ainda é uma abordagem tradicional na prática médica-odontológica, na qual evidências são coletadas por meio fotográfico e radiológico. Neste contexto, a Autópsia Virtual surge como [...] uma ferramenta útil e complementar para o exame cadavérico. Através da alta tecnologia radiológica a Autópsia Virtual fornece uma visão eficiente e precisa do caso a ser analisado. Esta revisão crítica tem o objetivo de atualizar os Cirurgiões-dentistas apresentando o primeiro trabalho com o conteúdo voltado a Autópsia Virtual. Abstract in english Nowadays, technological advances are becoming more and more important in forensic sciences. Yet autopsy is still one of the very traditional methods. This also applies for dentalautopsies, in which visual, photographic and radiological evidences are collected. In this context, Virtual Autopsy appear [...] s as a helpful and complementary tool for dental and medical cadaveric examination. Usinghigh-tech radiological approaches, Virtual Autopsy may provide, through images, an efficient and more accurate view on the individual case. This critical review aims to update the dental professionalspresenting the first national paper with explanations on Virtual Autopsy.

  18. Postmortem CT morphometry of great vessels with regard to the cause of death for investigating terminal circulatory status in forensic autopsy.

    Science.gov (United States)

    Sogawa, Nozomi; Michiue, Tomomi; Ishikawa, Takaki; Inamori-Kawamoto, Osamu; Oritani, Shigeki; Maeda, Hitoshi

    2015-05-01

    Postmortem CT (PM-CT) is useful to investigate the viscera in situ before opening the body cavities at autopsy. The present study involved a virtual morphometric analysis of thoracic and abdominal great vessels with regard to the cause of death as a possible index of terminal circulatory status in forensic autopsy cases, using PM-CT data of forensic autopsy cases within 3 days postmortem (n?=?93). Perimeters and cross-sectional areas of the aorta and vena cava depended on the age and/or gender of subjects; however, when the vessel flattening index (vFI) was calculated as the ratio of the cross-sectional area (a) to the estimated circle area having the same perimeter (l), using the formula vFI?=?4?a/l(2), the vFI showed distinct differences among the causes of death without significant postmortem time dependence. The index was low for each vessel in fatal bleeding, while the vFI of the abdominal aorta and inferior vena cava was low in hyperthermia (heatstroke), but higher in drowning, hypothermia (cold exposure) and sudden cardiac death. These CT findings provide quantitative data as supplementary indicators to reinforce autopsy findings for interpreting terminal circulatory status. PMID:25194711

  19. Investigation of a fatal airplane crash: autopsy, computed tomography, and injury pattern analysis used to determine who was steering the plane at time of accident. A case report.

    DEFF Research Database (Denmark)

    HØyer, Christian Bjerre; Nielsen, Trine Skov

    2012-01-01

    A fatal accident is reported in which a small single-engine light airplane crashed. The airplane carried two persons in the front seats, both of whom possessed valid pilot certificates. Both victims were subject to autopsy, including post-mortem computed tomography scanning (PMCT) prior to the autopsy. The autopsies showed massive destruction to the bodies of the two victims but did not identify any signs of acute or chronic medical conditions that could explain loss of control of the airplane. PMCT, histological examination, and forensic chemical analysis also failed to identify an explanation for the crash. A detailed review of an airplane identical to the crashed airplane was performed in collaboration with the Danish Accident Investigation Board and the Danish National Police, National Centre of Forensic Services. The injuries were described using the abbreviated injury scale, the injury severity score, 3-dimensional reconstructions of the PMCT, and an injury pattern analysis. We describe how, on basis ofthese data, we reached a conclusion about which of the two victims was the most likely to have been in control of the airplane at the time of accident. Furthermore, we argue that all victims of fatal airplane crashes should be subject to forensic autopsy, including PMCT and forensic chemical analysis. The continuous accumulation of knowledge about injury patterns from “simple” accidents is the foundation for the correct analysis of “difficult” accidents.

  20. [Pulmonary veno-occlusive disease in a patient with HIV infection. A case report with autopsy findings].

    Science.gov (United States)

    Hourseau, Muriel; Capron, Frédérique; Nunes, Hilario; Godmer, Pascal; Martin, Antoine; Kambouchner, Marianne

    2002-12-01

    We relate the autopsy findings of a case of pulmonary veno-occlusive disease which occurred in an HIV-infected intravenous drug abuser. This exceedingly rare disease, of unknown cause, is responsible for 10% of primary pulmonary hypertension. Histologically, the disease is characterized by a fibrous intimal thickening of small and medium sized pulmonary veins associated with congestive and dilated capillary network and alveolar haemorrhage. The occurrence of primary pulmonary hypertension in HIV positive patients is 25 times more frequent than in the general population. This is the third reported case of pulmonary veno-occlusive disease occurring in a HIV positive patient. It suggests the role of HIV in the pathogenesis of these vascular lesions. PMID:12594391

  1. Abnormalities in the mitral valve apparatus in patients undergoing long-term hemodialysis. Autopsy and echocardiographic correlation.

    Science.gov (United States)

    Abrahams, C; D'Cruz, I; Kathpalia, S

    1982-10-01

    Examination of the heart at autopsy in patients who received long-term hemodialysis revealed the following two changes in the mitral valve apparatus previously almost completely overlooked: (1) fibrosis and thickening affecting chordae tendineae in four cases: in one, severe mitral regurgitation was documented by hemodynamic studies; (2) extensive calcification in the mitral anulus region in two cases, with calcification in the base of the mitral leaflets in one and in the papillary muscle and chordae tendineae in the other. The causes of these abnormalities is unclear. Rheumatic and other known causes all seem unlikely origins of the extensive fibrosis. Secondary hyperparathyroidism is probably responsible for the calcification. In all six patients, these abnormalities in the mitral valve apparatus, which may be associated with functional impairment, were diagnosed during life by M-mode and two-dimensional echocardiography. PMID:7125766

  2. [Multiple malignant tumors combined with oral cancer from annual of the pathological autopsy cases in Japan, 1984-1988].

    Science.gov (United States)

    Takita, M; Taniguchi, B; Lin, Y; Ohmae, M; Machiya, T; Kawamoto, T; Okunishi, Y; Sakuda, M

    1990-06-01

    During the 5-year period from 1984 to 1988, a total of 944 cases had been presented multiple (3 or more) primary malignant tumors in annual of the pathological autopsy cases in Japan. Forty-one cases (4.3%) had lip and oral cancer. Of this group, triple were described 36 cases, quadruple 3 cases and more discrete multiple 2 cases, respectively. It is more frequent in men than in women, the ratio being 12.7:1. The age range is from 34 to 86 years with a mean of 66.9 years. In these cases with oral cancer, the another primary site is almost always found in digestive system (90.2%), e.g. esophagus (36.6%), stomach (34.1%) and colon and rectum (34.1%). PMID:2135415

  3. Neonatal mortality in India's rural poor: Findings of a household survey and verbal autopsy study in Rajasthan, Bihar and Odisha.

    Science.gov (United States)

    Dogra, Vishal; Khanna, Rajesh; Jain, Anuradha; Kumar, Ajay M V; Shewade, Hemant D; Majumdar, Suman S

    2015-06-01

    In 2011, Save the Children India launched a project for the disadvantaged population of Rajasthan, Bihar and Odisha. As a baseline activity, neonatal deaths during January-December 2012 were investigated using modified verbal autopsy tool in six sub-district-level administrative units (blocks) adopting 30-cluster sample survey approach. Our study reported a total of 189 neonatal deaths of which 50% occurred at home and 39% happened on Day 1. About half of the deaths occurred in blocks from Bihar. High number of neonatal deaths belonged to households that were below poverty line (64%) and other disadvantaged classes (46%); among mothers who were illiterate (65%), order births (36%). Birth asphyxia was a major cause of neonatal deaths across all blocks. These findings indicate need for easy and early access to transport services, specialized neonatal care and advocacy targeted towards increasing community awareness. PMID:25825343

  4. Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias / Morphological prognostic factors in nosocomial pneumonia: an autopsy study

    Scientific Electronic Library Online (English)

    Luiz Mário Baptista, Martinelli; Paulo José Fortes Villas, Boas; Thais Thomaz, Queluz; Hugo Hyung Bok, Yoo.

    2010-02-01

    Full Text Available OBJETIVO: Determinar a prevalência de pneumonia nosocomial nas autópsias em um hospital público universitário; identificar os fatores de risco relacionados à pneumonia nosocomial e os potenciais fatores prognósticos relacionados à ocorrência de pneumonia nosocomial fatal; e correlacionar os achados [...] anatomopatológicos com a ocorrência de pneumonia nosocomial e/ou pneumonia aspirativa. MÉTODOS: Estudo retrospectivo de 199 pacientes autopsiados, maiores de 1 ano de idade, internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista entre 1999 e 2006, cuja causa de morte (causa básica ou associada) foi pneumonia nosocomial. Testou-se a associação dos dados demográficos, clínicos e anatomopatológicos com os desfechos pneumonia nosocomial fatal e pneumonia aspirativa fatal. As variáveis significativas entraram na análise multivariada. RESULTADOS: A idade média foi de 59 ± 19 anos. A prevalência de pneumonia nosocomial em autópsias foi 29%, e essa foi a causa mortis de 22,6% dos pacientes autopsiados. A pneumonia nosocomial fatal correlacionou-se com os achados anatomopatológicos de alterações estruturais tabágicas (OR = 3,23; IC95%: 1,26-2,95; p = 0,02) e acometimento pulmonar bilateral (OR = 3,23; IC95%: 1,26-8,30; p = 0,01). Não houve associações significativas entre as variáveis e pneumonia aspirativa fatal. CONCLUSÕES: Em nossa amostra, a pneumonia nosocomial teve prevalência elevada e foi responsável por quase 25% das mortes. A mortalidade é favorecida por alterações estruturais tabágicas e pneumonia bilateral. Esses achados corroboram os resultados de diversos estudos clínicos sobre pneumonia nosocomial. Abstract in english OBJECTIVE: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whe [...] ther anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. METHODS: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. RESULTS: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco-associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. CONCLUSIONS: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.

  5. Fibrosing mediastinitis due to Aspergillus with dominant cardiac involvement: report of two autopsy cases with review of literature.

    Science.gov (United States)

    Chatterjee, Debajyoti; Bal, Amanjit; Singhal, Manphool; Vijayvergiya, Rajesh; Das, Ashim

    2014-01-01

    Fibrosing mediastinitis (FM) is a rare condition characterized by extensive proliferation of fibrous tissue in the mediastinum resulting in mass like lesion. Histoplasma and Mycobacterium tuberculosis are the common infective causes of fibrosing mediastinitis, but Aspergillus infection is an extremely rare cause. Fibrosing mediastinitis due to Aspergillus usually occurs following Aspergillus bronchopneumonia. Cardiac involvement due to Aspergillus-related fibrosing mediastinitis is extremely rare in immune-competent individuals and occurs following some intervention or as a part of disseminated systemic fungal infection. Here, we report two cases of Aspergillus FM with dominant cardiac involvement in immune-competent patients. Both cases presented with large mediastinal mass and large vegetation in the left atrium. Autopsy findings showed the granulomatous Aspergillus mediastinitis and extension into the heart with associated fibrosis. One case was proven to be due to Aspergillus flavus by fungal genomic sequencing. To the best of our knowledge, this is the first report of Aspergillus FM with pancarditis. PMID:24998315

  6. Role of interleukin-6 -174 G/C promoter polymorphism in trace metal levels of autopsy kidney and liver tissues.

    Science.gov (United States)

    Yalç?n, Serap; Kayaalt?, Zeliha; Söylemezo?lu, Tülin

    2011-06-01

    Interleukin-6 (IL-6) gene is a multifunctional cytokine which is expressed in lymphocytes, fibroblasts, macrophages, in response to different types of inflammatory stimuli. IL-6 also controls induction and expression of metallothioneins (MTs) which maintain homeostasis of zinc and copper. In human, IL-6 gene is located on chromosome 7p21 and -174 G/C polymorphism located in its promoter region. Recently, genetic studies showed that IL-6 -174 G/C promoter polymorphism influences IL-6 gene transcription and plasma cytokine levels. The aim of this study is to determine the IL-6 promoter polymorphism effect on trace element levels and toxic metal accumulation in the kidney and liver tissues. Kidney and liver tissues were collected from 122 autopsy cases in Ankara district. IL-6 promoter polymorphism was detected by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. The genotype frequencies were found as 54.9% homozygote typical (GG), 39.3% heterozygote (GC) and 5.7% homozygote atypical (CC). The allele frequencies in all subjects were consistent with Hardy-Weinberg equilibrium (?(2) = 0.179; p > 0.05). In order to assess the cadmium (Cd), lead (Pb), zinc (Zn) and copper (Cu) levels in the autopsy tissues, a dual atomic absorption spectrophotometer system was used. As a result, no statistical association was found between the IL-6 promoter polymorphism and Pb, Cd, and Cu (p > 0.05) levels in the kidney and liver tissues but statistically significant differences were detected with the Zn concentration (p < 0.05). PMID:21333594

  7. Multiorgan gadolinium (Gd) deposition and fibrosis in a patient with nephrogenic systemic fibrosis--an autopsy-based review

    DEFF Research Database (Denmark)

    Sanyal, Soma; Marckmann, Peter

    2011-01-01

    BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a systemic disorder of patients with severe renal insufficiency who have received gadolinium (Gd)-based magnetic resonance contrast agents (GBCAs). The causative association with Gd exposure was strengthened by the demonstration of Gd in various tissues of NSF patients, predominantly at the bulk chemical level. The distribution of Gd at the histologic level of organs other than skin has not been reported previously. METHODS: We analysed tissues from an autopsy case with verified advanced NSF by light microscopy and scanning electron microscopy/energy-dispersive X-ray spectroscopy. Furthermore, we reviewed published literature to compare the histological and histochemical findings in NSF patients and chronic renal failure (CRF) patients without NSF. RESULTS: Insoluble Gd-phosphate deposits were detected in the skin, liver, lungs, intestinal wall (ileum), kidney, lymph node, skeletal muscle, dura mater and cerebellum of the NSF autopsy case, primarily in vascular walls. Some, but not all, Gd deposits were seen in fibrotic areas. Literature review highlighted that non-specific tissue fibrosis and calcification are frequent findings in tissues of patients with CRF with and without NSF. CONCLUSIONS: Vascular and extracellular Gd deposits are found in multiple organs of NSF patients, associated with calcification, and often in fibrotic areas. Gd deposits are not seen in patients with CRF unexposed to GBCAs but rarely may be seen in GBCA-exposed patients without clinical signs of NSF. Apart from diagnostic findings in skin, fibrosis of muscle and dura may be more prominent in NSF patients. Our findings should stimulate further investigation of mechanisms of fibrosis and pathologic calcification.

  8. Líneas guía en autopsias por sospecha de mala praxis asistencial / Guidelines of autopsy in cases of suspected clinical malpractice

    Scientific Electronic Library Online (English)

    J., Aso Escario.

    2011-12-01

    Full Text Available El presente trabajo revisa las líneas seguidas en casos de autopsia por sospecha de mala praxis. Se revisan las indicaciones, propósitos generales, técnicas de disección, exámenes complementarios, junto con los problemas éticos, de acuerdo con la experiencia del autor y la literatura. Un grado signi [...] ficativo de entrenamiento y experiencia tanto clínica como patológica es requerido en estos casos. Esta necesidad puede contrastar con la relativa falta de expertizatión de los médicos forenses en España, y con las limitaciones de la autopsia médico-legal. Algunas guías para solucionar este problema, como consulta con especialistas independientes, o con los comités de las especialidades médicas, son consideradas. Existen importantes problemas éticos en estos fallecimientos. En consecuencia, hay una necesidad de enfoque correcto de estos problemas. Se consideran algunas orientaciones en este sentido. Abstract in english The present paper reviews the guidelines for autopsy in cases of suspected clinical malpractice. Indications, general purposes, dissection techniques, laboratory and complementary examinations, as well as ethical problems are revised, according to the author's experience and literature review. A sig [...] nificant degree of training and skill, both clinical and pathologically, are required. This needing can contrast with the relative lack of specialization of Forensic Pathologists in Spain, and limitations of the judicial autopsy in these cases. Some guidelines to solve this problem, like independent expert consultation or advise by the Specialties Boards, are considered. Important ethical issues can arise from these deaths, therefore, a needing of correct address of these issues is perceived. Some orientations in this subject are considered.

  9. Discrepâncias clínico-patológicas e achados cardiovasculares em 409 autópsias consecutivas / Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

    Scientific Electronic Library Online (English)

    Aline Fusco, Fares; Jorge, Fares; Gislaine Fusco, Fares; José Antônio, Cordeiro; Marcelo Arruda, Nakazone; Patrícia Maluf, Cury.

    2011-12-01

    Full Text Available FUNDAMENTO: As discrepâncias entre os diagnósticos clínicos e em autópsia persistem em todo o mundo. OBJETIVO: Avaliamos as autópsias em um hospital-escola para analisar a precisão dos diagnósticos cardiovasculares clínicos em comparação aos achados post-mortem. MÉTODOS: As 409 autópsias consecutiva [...] s entre 2003 e 2006 foram analisadas em um hospital terciário de São José do Rio Preto, São Paulo (SP), Brasil. A comparação dos achados cardiovasculares clínicos e patológicos foi realizada por meio da classificação de discrepâncias de Goldman. RESULTADOS: A taxa de autópsia no hospital foi de 8%. As causas cardiovasculares de óbito representavam 42,8% (175 de 409 pacientes) dos diagnósticos de autópsia. Em 98 pacientes (56%), houve discrepâncias significativas (classes I e II), o que representa uma grande proporção de diagnósticos equivocados de infarto mesentérico (84,6%), infarto agudo do miocárdio (64,7%), dissecção da aorta (64,2%) e embolia pulmonar (62,5%). Foram observadas maiores taxas de concordância para a insuficiência cardíaca congestiva (59%) e para o acidente vascular cerebral isquêmico agudo (58,8%). A idade, o sexo, o tempo de permanência e a última unidade de admissão no hospital não foram associados aos critérios de Goldman. CONCLUSÃO: As discrepâncias dos diagnósticos clínicos e em autópsia relativos à morte cardiovascular permanecem elevados no Brasil, a despeito dos recursos tecnológicos disponíveis. Além disso, nossos achados reforçam a importância do exame post-mortem como uma contribuição para a melhoria da assistência médica. Abstract in english BACKGROUND: Discrepancies between clinical and autopsy diagnoses persists worldwide. OBJECTIVE: We evaluated autopsies in a university hospital in order to assess the accuracy of clinical cardiovascular diagnosis compared to postmortem findings. METHODS: Four hundred nine consecutive autopsies betwe [...] en 2003 and 2006 were analyzed in a tertiary-care hospital in São José do Rio Preto, SP, Brazil. The comparison of clinic-pathological cardiovascular findings was performed using Goldman's discrepancies classification. RESULTS: Autopsy rate at the hospital was 8%. Cardiovascular causes of death represented 42.8% (175 out of 409 patients) of autopsy diagnoses. In 98 (56%) patients, there were major discrepancies (class I and II), representing a large proportion of misdiagnoses for mesenteric infarction (84.6%), acute myocardial infarction (64.7%), aorta dissection (64.2%), and pulmonary embolism (62.5%). Highest concordance rates were observed in congestive heart failure (59%) and acute ischemic stroke (58.8%). Age, sex, length of stay and the last admission unit at the hospital were not associated with Goldman criteria. CONCLUSION: Clinic-autopsy discrepancies concerning cardiovascular death remain high in Brazil, despite technological resources available. Moreover, our findings reinforce the importance of postmortem examination in contributing to medical care improvement.

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

    Directory of Open Access Journals (Sweden)

    Ding Ding

    2011-08-01

    Full Text Available 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 cancer rates in this area. Methods An epidemiologic study was designed to compare numbers of deaths and causes of death between the study areas with water pollution and the control areas without water pollution in S County and Y District in 2005. The study areas were selected based on the distribution of the Huai River and its tributaries. Verbal autopsy was used to assist cause of death (COD diagnoses and to verify mortality rates. The standard mortality rates (SMRs of cancer in the study area were compared with those in the control areas. In order to verify the difference between mortality rates due to cancers in the study and the control areas, patients who reported having cancer in the survey received a second diagnosis by national and provincial oncologists with pathological and laboratory examinations. Comparisons were made to determine if differential cancer prevalence rates in the study and control areas were similar to the difference in mortality due to cancer in these study and control areas. Mortality rates of cancers in study and control areas were also compared with national statistics for the rural population of China. Results Over five years, 3,301 deaths were identified, including 1,158 cancer deaths. The annual average SMRs of cancer in the study areas of S County and Y District were 277.8/100,000 and 223.6/100,000, respectively, which is three to four times higher than those in the control areas. In addition, a total of 626 cases of cancer in the study and control areas were confirmed. The prevalence rates of cancer were 545/100,000 and 128.1/100,000 per year in the study and control areas in S County, respectively, and 440.9/100,000 and 200/100,000 per year in the study and control areas in Y District, respectively. The mortality and prevalence rates of digestive cancers were higher in the study areas than the control areas. In 2000, the SMR for cancer in rural areas nationwide was 120.9/100,000, and in study areas in S County and Y District, the excess rates of deaths were 184/100,000 and 138.8/100,000, respectively. Conclusions The death rates of digestive cancers were much higher in the study areas of S County and Y District. The patterns for between-area differences in prevalence and mortality rates of cancer were similar. Verbal autopsy is shown to be a useful tool in retrospective mortality surveys in low-resource areas with limited access to health care.

  11. A lesão apical em cardiopatas chagásicos crônicos: estudo necroscópico Apical lesions in Chagas' heart disease patients: an autopsy study

    Directory of Open Access Journals (Sweden)

    Cristina Brandt Friedrich Martin Gurgel

    2010-12-01

    Full Text Available INTRODUÇÃO: A lesão apical ventricular é típica da cardiopatia chagásica e sua presença representa risco de fenômenos tromboembólicos. O objetivo deste trabalho é avaliar a frequência de LA à necropsia de portadores de cardiopatia chagásica crônica. MÉTODOS: Análise retrospectiva de necropsias de chagásicos maiores que 17 anos. Efetuada análise estatística comparativa das variáveis clínicas e dos achados necroscópicos entre o grupo A (com lesão apical e o grupo B (ausência de lesão apical. RESULTADOS: Estudados 51 casos: 25 no grupo A (idade média de 53 anos, 64% do sexo masculinoe 26 no B.. A LA localizava-se no ventrículo esquerdo em 80% casos. No grupo B, a média de idade foi de 56 anos e 46,1% eram do sexo masculino. A forma clínica prevalente nos dois grupos foi a miopática, mas arritmia cardíaca também esteve presente em ambos (57,9% no grupo A e 32,1% no B. Foi constatada a presença de trombos em 60% dos casos do grupo A (53,3% localizados na LA e 30,7% no B; CONCLUSÕES: Houve predomínio da forma miopática nos casos com LA, com média de peso cardíaco maior em relação ao B. Em ambos os grupos observamos relação diretamente proporcional entre maior peso cardíaco e presença de tromboses. Houve predomínio do número de tromboses no grupo A, mais de 50% eram localizadas na lesão, cujo diferencial clínico principal consistiu na presença maior de arritmias. A miopatia (com aumento de peso acima de 500g foi primordial para aparecimento de tromboses.INTRODUCTION: The presence of an apical ventricular lesion increases the risk of intracardiac thrombosis and thromboembolic phenomena. The study evaluated the incidence of apical lesions and intracardiac thrombosis in Chagas' heart disease patients at autopsy. METHODS: A retrospective review of autopsies of Chagas' heart disease patients was conducted. Statistical analysis included comparison of clinical variables and autopsy findings between two groups: group A (apical lesions and group B (no apical lesions. RESULTS: A total of 51 cases of Chagas' disease patients were studied: 25 in group A (mean age 53 years-old; 64% male and 26 in group B. Apical lesions were verified in the left ventricle in 80% of cases. The prevalent clinical subtype in both groups was myopathic, but significant cardiac arrhythmia was present in 57.9% of patients in group A, while 76.9% in group B did not present arrhythmias. Mean heart weight was 500.9g in group A and 408.4g in group B. The presence of thrombosis occurred in 60% of group A with 8 (53.3% thrombi occurring in the apical lesion. CONCLUSIONS: The myopathic subtype was the most common clinical form in group A and the mean heart weight was statistically higher in this group. Clear prevalence of thrombosis was verified in group A, with 50% located in the apical lesion, whose main differential factor was a greater incidence of arrhythmias. Myopathy (heart weight above 500g was primordial for the presence of thrombosis in both groups.

  12. Hipertrofia cardíaca esquerda e direita em necropsias de hipertensos / Left and right ventricular hypertrophy at autopsy of hypertensive individuals

    Scientific Electronic Library Online (English)

    Mirella Pessoa, Sant' Anna; Roberto José Vieira de, Mello; Luciano Tavares, Montenegro; Mônica Modesto, Araújo.

    2012-02-01

    Full Text Available OBJETIVO: Medir a espessura ventricular direita e esquerda em falecidos com história de hipertensão arterial, submetidos a necropsias clínicas. MÉTODOS: Foram selecionados 90 casos do Serviço de Verificação de Óbitos de Recife -PE, de ambos os sexos, com história de hipertensão arterial essencial, c [...] om relação à espessura das paredes cardíacas, além da correlação com outros achados de necropsia e informes clínicos. RESULTADOS: Observouse associação significativa entre a presença de hipertrofia ventricular esquerda (HVE) e direita (HVD), e de cardiopatia hipertensiva grave e HVD. Houve predomínio da HVD e HVE em homens, na faixa etária dos 60-79 anos, com maior prevalência nas etnias parda e negra, e naqueles com estado nutricional adequado ou com sobrepeso e em obesos. CONCLUSÃO: Observou-se que a presença de HVD relaciona-se com HVE, sugerindo que há fatores patogênicos semelhantes envolvidos no desenvolvimento da hipertrofia bilateral. A HVD parece associar-se à doença cardíaca mais grave, podendo, a partir de outros estudos, ser considerada novo fator prognóstico na avaliação dos pacientes hipertensos. Abstract in english OBJECTIVE: To measure the right and left ventricular thickness in deceased individuals with a history of hypertension submitted to clinical autopsies. METHODS: We selected 90 cases from the Death Verification Service of the city of Recife, state of Pernambuco, Brazil, of both sexes, with a history o [...] f essential arterial hypertension related to heart wall thickness, in addition to correlation with autopsy findings and other clinical reports. RESULTS: There was a significant association between the presence of left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH) and between severe hypertensive cardiomyopathy and RVH. There was a predominance of RVH and LVH in men aged 60-79 years and a higher prevalence in the Brazilian mulatto and Black ethnic groups and in those with adequate nutritional status or overweight and obese individuals. CONCLUSION: It was observed that the presence of RVH was related to LVH, suggesting that there are similar pathogenic factors involved in the development of bilateral hypertrophy. The RVH seems to be associated with more severe heart disease and may, based on other studies, be considered as a new prognostic factor in the evaluation of hypertensive patients.

  13. Patients with pelvic fractures due to falls: A paradigm that contributed to autopsy-based audit of trauma in Greece

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    Kotsilianou Olympia

    2011-01-01

    Full Text Available Abstract Background Evaluation of the pelvic fractures (PFx population in auditing effective components of trauma care is the subject of this study. Methods A retrospective, case-control, autopsy-based study compared a population with PFx to a control-group using a template with trauma outcome variables, which included demographics, ICD-9, intention, mechanisms, toxicology, Abbreviated Injury Scale (AIS-90, Injury Severity Score (ISS, causes of haemorrhage, comorbidity, survival time, pre-hospital response, in hospital data, location of death, and preventable deaths. Results Of 970 consecutive patients with fatal falls, 209 (21.5% had PFx and constituted the PFx-group while 761 (78.5% formed the control-group. Multivariate analysis showed that gender, age, intention, and height of fall were risk factors for PFx. A 300% higher odds of a psychiatric history was found in the PFx-group compared to the control-group (p The median ISS was 50 (17-75 for the PFx-group and 26 (1-75 for the control-group (p Associated injuries were significantly more common in the PFx-group than in the control-group. Potentially preventable deaths (ISS A subset of 126 (60.3% potentially preventable deaths in the PFx-group had at least one AIS-90 code other than the PFx, denoting major haemorrhage. Deaths directly attributed to PFx were limited to 6 (2.9%. The median survival time was 30 minutes for the PFx-group and 20 hours for the control-group (p Pre-hospital mortality was significantly higher in the PFx-group i.e. 70.3% of the PFx-group versus 42.7% of the control-group (p Conclusions The PFx-group shared common causative risk factors, high severity and multiplicity of injuries that define the PFx-group as a paradigm of injury for audit. This reduced sample of autopsies substantially contributed to the audit of functional, infrastructural, management and prevention issues requiring transformation to reduce mortality.

  14. Observar, ouvir, compartilhar: trabalho de campo para autópsias psicossociais / Watching, listening and sharing: field work for psychosocial autopsies

    Scientific Electronic Library Online (English)

    Maria Cecília de Souza, Minayo; Sonia, Grubits; Fátima Gonçalves, Cavalcante.

    2012-08-01

    Full Text Available O artigo descreve as etapas de realização do trabalho de campo da pesquisa. É possível prevenir a antecipação do fim? Suicídio de Idosos no Brasil e possibilidades de Atuação do Setor de Saúde, realizada em 10 municípios das cinco regiões do país. A amostra composta por 51 autópsias psicossociais ab [...] rangeu cinco idosos que faleceram por suicídio em nove municípios e seis em um deles. Oitenta e quatro familiares foram entrevistados. Trabalhou-se com um roteiro denominado autópsia psicossocial e com observação do contexto. Cada entrevista durou 60 minutos em média, e na maioria dos casos, houve mais de um encontro com os familiares. O estudo foi construído por meio de um processo coletivo que abrangeu compartilhamento da revisão bibliográfica, discussão do universo, das amostras, das estratégias de abordagem, dos resultados de campo e das análises empíricas. Este artigo destaca a preparação teórica, conceitual e prática dos pesquisadores; o processo de elaboração dos instrumentos para o trabalho de campo; informações sobre as fontes de dados existentes e sobre as efetivamente acessadas; apresentação de credencial institucional; entrada no contexto das famílias, dificuldades e estratégias para realização do estudo empírico; entrada e saída do campo; e impacto da pesquisa sobre os investigadores. Abstract in english The article describes the research realization phases of field work in ten municipalities in five regions entitled "Is it possible to prevent the anticipation of the end? Suicide among the elderly in Brazil and the possibilities for action by the Health Sector." The sample comprises 51 psychosocial [...] autopsies of 5 elderly people who committed suicide in 9 locations and 6 in another. 84 family members were interviewed. Semi-structured psychosocial autopsies and contextual observations were used. Each interview lasted 60 minutes on average and in the majority of the cases there was more than one encounter with family members. The study consisted of a collective process that involved bibliographic review, discussion of the samples, approach strategies, field results and empirical analysis. This article highlights the theoretical, conceptual and practical preparation of researchers and production and standardization of instruments; information about existing data sources and those that are actually used; introduction of institutional credentials; assessment of the family context, difficulties and strategies for empirical study; entrance to and exit from the field; and the impact of the research on the investigators.

  15. Characteristics of cirrhosis undiagnosed during life: a comparative analysis of 73 undiagnosed cases and 149 diagnosed cases of cirrhosis, detected in 4929 consecutive autopsies.

    DEFF Research Database (Denmark)

    Graudal, Niels; Leth, Peter Mygind

    1991-01-01

    In 4929 consecutive autopsies performed during a period of 4 years, 222 cases (4.5%) of cirrhosis were found, of which 149 (3%) were detected while the patients were alive (diagnosed cirrhosis) and 73 (1.5%) were not detected while the patients were living (undiagnosed cirrhosis). Fifty-three of the 73 undiagnosed patients appeared to be completely without signs of cirrhosis (silent cirrhosis). In the diagnosed group, 70% of patients died from hepatic causes, in contrast to 16% in the undiagnosed group. At autopsy, the following complications of cirrhosis were found more frequently in the diagnosed group than in the undiagnosed group: ascites (41% vs. 8%), oesophageal varices (44% vs. 10%), splenomegaly (52% vs. 29%). The prevalence of hepatocellular carcinoma did not differ significantly in the two groups (12% vs. 8%). It is concluded that cirrhosis without obvious signs occurs relatively frequently, and that no sensitive non-invasive screening methods are available at present.

  16. Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis.

    Science.gov (United States)

    Bury, Danielle; Langlois, Neil; Byard, Roger W

    2012-03-01

    In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids. PMID:21981407

  17. The 2002 results of the first series of follow-up studies on Japanese Thorotrast patients and their relationships to autopsy series

    International Nuclear Information System (INIS)

    In 1963, a follow-up study was started on 262 war-wounded Japanese ex-servicemen who had been injected with thorotrast into blood vessels between 1931 and 1945. This first series of our follow-up studies on thorotrast patients covered a total of 71 years from 1931 to the present 2002 survey. It was supplemented in 1979 by another follow-up study called the second or Aichi series performed on other thorotrast-injected war-wounded persons. The 2002 survey of the first series indicated that 5 (1.9%) of 262 thorotrast cases were still alive, while 257 (98.1%) had died. Among 1,630 control war-wounded persons not treated with thorotrast, 348 (21.3%) were still alive and 1,282 (78.7%) had died. In an age-matched control population of 3,999,000 persons, 837,175 (20.9%) were alive and 3,161,825 (79.1%) had died. The life span of thorotrast patients was; thus, markedly shorten (about 18 years, P2 test showed that the incidence of these disorders was significantly higher in the thorotrast group than the control group. From 1945 to 2002, autopsies have been performed on 404 thorotrast-treated-patients - 392 injected with thorotrast by vascular route and 12 injected by other routes. In vascularly injected aut other routes. In vascularly injected autopsy cases, 266 liver malignancies (67.9%), 28 liver cirrhoses (7.1%), 12 cancers of extrahepatic bile duct (3.1%), 30 hematopoietic malignancies (7.7%); 2 bone sarcomas (0.5%), 16 lung cancers (4.1%), one hemangiosarcoma of the spleen (0.3%), 4 malignant peritoneal tumors (1.0%), and 7 sarcomas at the injection site (1.8%) were found. The relative risk estimate of liver malignancies and hematopoietic malignancies was significantly higher in the autopsied thorotrast patients than in the autopsied controls. (orig.)

  18. Two autopsy cases of severe fever with thrombocytopenia syndrome (SFTS) in Japan: a pathognomonic histological feature and unique complication of SFTS.

    Science.gov (United States)

    Hiraki, Tsubasa; Yoshimitsu, Makoto; Suzuki, Tadaki; Goto, Yuko; Higashi, Michiyo; Yokoyama, Seiya; Tabuchi, Tomohisa; Futatsuki, Takahiro; Nakamura, Kentaro; Hasegawa, Hideki; Saijo, Masayuki; Kakihana, Yasuyuki; Arima, Naomichi; Yonezawa, Suguru

    2014-11-01

    We report two autopsy cases of severe fever with thrombocytopenia syndrome (SFTS) with a high fatality rate in aged Japanese patients. Both cases were caused by a tick-bite. The pathognomonic histological feature was necrotizing lymphadenitis of systemic lymphoid tissue with SFTS viruses and SFTSV-RNA copies. Marked fungal infections were also observed in the lungs of both patients. Since cellular immune function may be suppressed in SFTS patients, physicians should be aware of possible fungal infections. PMID:25329676

  19. Moving from Data on Deaths to Public Health Policy in Agincourt, South Africa: Approaches to Analysing and Understanding Verbal Autopsy Findings

    OpenAIRE

    Byass, Peter; Kahn, Kathleen; Fottrell, Edward; COLLINSON, MARK A.; Tollman, Stephen M

    2010-01-01

    Background: Cause of death data are an essential source for public health planning, but their availability and quality are lacking in many parts of the world. Interviewing family and friends after a death has occurred (a procedure known as verbal autopsy) provides a source of data where deaths otherwise go unregistered; but sound methods for interpreting and analysing the ensuing data are essential. Two main approaches are commonly used: either physicians review individual interview material ...

  20. Aplicación del sistema de puntuación del daño múltiple de órganos en autopsias / Application of the scoring system of multiple organ failure at autopsy

    Scientific Electronic Library Online (English)

    Idalmis, Rodríguez Rivera; Teresita, Montero González; José Hurtado, de Mendoza Amat; Pablo Luis, Cabrera Rosell.

    2012-12-01

    Full Text Available Introducción: el estudio sistemático de las autopsias ha permitido caracterizar el daño múltiple de órganos. El sistema de puntuación, comprobado primero en un modelo experimental y adaptado posteriormente a la morfología humana, permite modificar los criterios diagnósticos sobre dicho daño, y por e [...] nde, una interpretación más objetiva del estudio. Objetivo: caracterizar el empleo del referido sistema de puntuación en la práctica del trabajo asistencial para estudiar las autopsias. Métodos: se revisaron las autopsias contenidas en la base de datos del Sistema Automatizado de Registro y Control de Anatomía Patológica para identificar el diagnóstico del daño y reevaluarlos con los criterios actuales. Resultados: la reevaluación de los casos mostró la presencia del daño múltiple de órganos en el 87 % de los casos estudiados, excluyendo al 13 % de este criterio diagnóstico. Conclusiones: el sistema de puntuación para el diagnóstico del daño múltiple de órganos aplicado en la reevaluación de autopsias, permite caracterizar con mayor precisión y objetividad este diagnóstico. Abstract in english Introduction: the systematic study of autopsies has allowed the characterization of multiple organ failure. The scoring system, first tested in experimental and subsequently adapted to human morphology, allows modifying the diagnostic criteria for such damage, and therefore a more objective interpre [...] tation of the study. Objective: To describe the use of this scoring system in practice care to study the autopsies. Methods: The autopsies, contained in the database of the Automated System of Registration and Control of Pathology, were reviewed to identify the diagnosis of the damage and reassess current criteria. Results: Re-assessment of cases showed the presence of multiple organ failure in 87 % of the cases studied, excluding 13 % from this diagnostic criterion. Conclusions: The scoring system for the diagnosis of multiple organ failure, applied for reassessing autopsies allows characterizing this diagnosis much precisely and objectively.

  1. A report of two cases: post flood autopsy findings in urban patients with an unusual presentation of leptospirosis with hemorrhagic pneumonia in government medical college, Surat

    OpenAIRE

    Mandakini M Patel, Bhavna Gamit, R D Patel, Rahul Modi

    2011-01-01

    South Gujarat is endemic zone for leptospirosis in paddy workers but recently we have post flood plenty of urban patients who were presented with high grade fever, dyspnea & haemoptysis with rapid deterioration. Clinicians were suspecting an outbreak of Hantavirus or leptospirosis. Both our patients were serologically negative for leptospirosis ante mortem, but alveolar hemorrhage & raised urea was the only finding. Both our patient rapidly deteriorated. We performed autopsy &...

  2. An autopsy report on multiple system atrophy diagnosed immunohistochemically despite severe ischaemic damage: a new approach for investigation of medical practice associated deaths in Japan

    OpenAIRE

    Nakajima, M.; Kojima, H.; Takazawa, Y.; Yahagi, N.; Harada, K.; Takahashi, K.; Unuma, K.; Yoshida, K.

    2009-01-01

    A 60-year old man with a 10-year history of multiple system atrophy (MSA) was found in respiratory arrest. After 4 months of respiratory support with two episodes of septic shock, he died. Autopsy disclosed severe atrophy of the mesencephalon, brainstem, medulla oblongata and cerebellum. Gallyas–Braak, ?-synuclein and ubiquitin-positive inclusions in the cytoplasm of glial cells were evident, despite the severe ischaemic damage due to respiratory arrest and subsequent respiratory support f...

  3. Immunohistochemical Expression of p16 and p21 in Pituitary Tissue Adjacent to Pituitary Adenoma versus Pituitary Tissue Obtained at Autopsy: Is There a Difference?

    Science.gov (United States)

    Manojlovic Gacic, Emilija; Skender-Gazibara, Milica; Soldatovic, Ivan; Dundjerovic, Dusko; Boricic, Novica; Raicevic, Savo; Popovic, Vera

    2015-05-01

    Normal pituitary tissue is frequently used for comparison with protein expression in tumor tissue, being obtained either at surgery or at autopsy. p16 and p21 proteins are cyclin-dependent kinase inhibitors, belonging to INK4 and Cip/Kip family, respectively. Their expression is increased in response to DNA damage or other cellular stressors, resulting in the activation of cell cycle checkpoints. They also play important roles in cellular senescence. The purpose of this study was to investigate differences in p16 and p21 immunohistochemical expression in normal pituitary tissue adjacent to pituitary adenoma obtained during neurosurgical procedure with pituitary tissue obtained at autopsy, from patients who died from non-endocrinological diseases. Our results show significant difference in p16 nuclear and p21 cytoplasmic immunohistochemical expression between two types of normal pituitary tissues. One of the reasons for this difference could be the age of subjects because those who underwent autopsy for a non-endocrinological disease were significantly older than subjects who underwent neurosurgery for a pituitary adenoma. Our finding that differences are probably not influenced by postmortem changes is supported by no significant correlation between postmortem interval and immunohistochemical p16 and p21 expression. The influence of the presence of a pituitary adenoma could not be evaluated in these specimens. PMID:25678367

  4. Autopsy studies of Hashimoto's thyroiditis in Hiroshima and Nagasaki (1954-1974): relation to atomic bomb radiation

    Energy Technology Data Exchange (ETDEWEB)

    Asano, M. (Radiation Effects Research Foundation, Hiroshima, Japan); Norman, J.E. Jr.; Kato, H.; Yagawa, K.

    1978-01-01

    The authors examined 155 autopsy cases of Hashimoto's thyroiditis in the Life Span Study sample including both A-bomb survivors and controls in Hiroshima and Nagasaki (1954 to 1974). Hashimoto's thyroiditis was classified into lymphoid, diffuse and fibrous types and the following results were obtained. No difference existed in the effects of A-bomb radiation in the incidence and ATB. The ratio of males to females did not reveal statistical significance, even though reversed ratio was noted in the high dose group. The variation of thyroid gland weight in T65 dose or by variant showed no significant pattern, even though the smallest average weight was found in the highest radiation exposure group. The complications in the patients with Hashimoto's thyroiditis were noted to have high prevalance of ovarian cancer and low prevalence of stomach cancer and total cancer. Only two patients with Hashimoto's thyroiditis were found to be complicated with thyroid carcinoma. Among collagen diseases, the prevalence of rheumatic fever and rheumatoid arthritis was high as complication. And the prevalence of combined diseases suggested that no late effect of A-bomb radiation existed.

  5. Microscopic epidural lesions in goats given repeated epidural injections of morphine: use of a modified autopsy procedure.

    Science.gov (United States)

    Larsen, J J; Svendsen, O; Andersen, H B

    1986-01-01

    Epidural catheterization was performed in six goats. Five days later either saline or 20 mg (5 mg/ml) preservative free morphine was injected epidurally once daily for 8 days. The goats were sacrificed 4, 24 or 48 hours after the last injection. The lumbar part of columna was removed in toto for microscopic examination of the spinal cord and the entire epidural space after decalcification and transverse sectioning. After saline, minimal changes including a fibrous membrane surrounding the catheter, scattered fat cell necrosis, scattered small focal cell infiltrations and occasionally focal haemorrhages were seen. After morphine the changes were considerably more severe including diffuse cellular inflammatory reaction in the epidural space, fat cell necrosis, occasionally focal exudative inflammation and chronic inflammatory reaction in the vicinity of the fibrous membrane demarcating position of the catheter. It is concluded that the present modified autopsy procedure permits microscopic examination of the epidural space. It has been shown that repeated administration of morphine caused tissue damage in the epidural space of goats. The human predictability of the results obtained is unknown. However, the results are encouraging for investigations with similar procedure in humans. PMID:3953294

  6. Autopsy findings of human fetuses of descendant (F1, F2) of the A-bomb survivors

    International Nuclear Information System (INIS)

    An analysis was made of autopsy population of human fetuses and neonates (652 cases for F1 and 115 cases for F2 ) obtained from A-bomb exposed and non-exposed groups. In a study of delivery mode, the incidence of abnormal findings, including congenital anomaly, was found higher in the group of spontaneous delivery than the group of artificial delivery. Anomaly of the heart or great vessels was the most common, followed by anomaly of the central nervous system and urinary system in both F1 and F2 groups. Abnormal findings in the group of spontaneous delivery were observed in a total of 148 cases. For evaluable 32 cases in which the exposure distance was confirmed, these abnormalities were not related to distance from the hypocenter. Anomaly in this group was seen in 74 cases, in which autosomal dominant inheritance had induced chondrodystrophy (two cases) and polycystic kidney disease (one). For F2, anomaly was observed in 22 cases in the group of spontaneous delivery. Polycystic kidney disease was seen in each one case exposed at ?2,000 m or 2,000-4,000 m from the hypocenter. The incidence of other anomalies was independent of exposure distance or either paternal or maternal exposure to A-bombing. Nor was correlation between the incidence of macerated fetuses and exposure distance or either paternal or maternal exposure. (N.K.)

  7. Pulmonary alveolar proteinosis and glomerulonephritis in lysinuric protein intolerance: case reports and autopsy findings of four pediatric patients.

    Science.gov (United States)

    Parto, K; Kallajoki, M; Aho, H; Simell, O

    1994-04-01

    Lysinuric protein intolerance is an autosomal recessive disease caused by defective transport of cationic amino acids. Of the 38 lysinuric protein intolerance patients diagnosed in Finland since 1965, four pediatric patients have died. We describe the clinical courses and autopsy findings for these patients. All patients developed acute respiratory insufficiency. In addition to pulmonary hemorrhages, three of the patients had pulmonary alveolar proteinosis and one had cholesterol granulomas. Three patients had a clinically obvious renal insufficiency, but all four showed histologic signs of immune complex-mediated glomerulonephritis. The patients also developed hepatic insufficiency with fatty degeneration or cirrhosis. All patients showed anemia, thrombocytopenia, and a severe bleeding tendency. The bone marrow of three patients was hypercellular, but the amount of megakaryocytes was decreased in two cases. Amyloid was present in the lymph nodes and the spleen. Bone specimens showed osteoporosis. We conclude that pediatric patients with lysinuric protein intolerance are predisposed to develop pulmonary alveolar proteinosis and glomerulonephritis. They are also at risk of protein malnutrition in the active growth phase, probably due to higher requirements for total nitrogen and amino acids. PMID:8163273

  8. Frequency of myocarditis in cases of fatal meningococcal infection in children: observations on 31 cases studied at autopsy

    Directory of Open Access Journals (Sweden)

    Garcia Norma S.

    1999-01-01

    Full Text Available The frequency of myocarditis associated with meningococcal disease in children was reported only in two autopsied series (United States and South Africa. Here we report the frequency of associated myocarditis in 31 children who died of meningoccal infection at Hospital Infantil N.S. da Glória in Vitória, Espirito Santo State, Brazil. The diagnosis was confirmed by isolation of Neisseria meningitidis . At least three sections of fragments of both atria and ventricles were studied using the Dallas Criteria for the morphologic diagnosis of myocarditis. The mean age was 47.6 ± 39.8 months and the mean survival time after the onset of symptoms was 46.1 ± 26.5h (12-112h. Myocarditis was present in 13 (41.9% patients, being of minimal severity in 11 cases and of moderate severity in 2 cases. There were no cases with severe diffuse myocarditis. The frequency of myocarditis was not influenced by sex, presence of meningitis, survival time after the onset of symptoms or use of vasoactive drugs. The frequency of myocarditis reported here was intermediate between the values reported in the only two case series published in the literature (57% in the United States and 27% in South Africa. Although our data confirm the high frequency of myocaditis in meningoccal disease, further investigations are necessary to elucidate the contribution of myocarditis to myocardial dysfunction observed in cases of meningococcal infection in children.

  9. Pathomorphology of the brain at autopsy in patients treated with radiation-chemoimmunotherapy (RAFP therapy) for malignant glioblastoma

    International Nuclear Information System (INIS)

    Fifteen patients with malignant glioblastoma (MGB) were treated with radiation and chemoimmunotherapy, consisting of ACNU + FT 207 + PSK, (RAFP therapy). Autopsy findings of the brain were examined pathomorphologically in these patients, and were compared with those in the other 15 MGB patients not treated with RAFP therapy. Viable tumor tissues massively remained in the primary tumor site in only three patients in the FAFP group; however, this finding was common in the control group (10/15). Tumor infiltration into the other cerebral lobes, contralateral cerebral hemisphere, and tumor tissues below the tentorium was infrequent and slight in the RAFP group, as compared with that in the control group. Radiation necrosis in the brain tissues surrounding the tumor was more noticeable in the FAFP group than in the control group. Widespread edema, which was considered due to radiation, was seen in association with damage in the brain parenchyma. Major causes of increased intracranial pressure were tumor necrotic lesions, their surrounding radiation-induced necrosis, and edema in the RAFP group, and an increase and infiltration of residual tumor tissues in the control group. The results suggest that radiation, as well as tumor size and infiltration, may have been responsible for severe failure of central nervous system function. (Namekawa, K.)

  10. [An autopsy case of rhino-orbito-cerebral mucormycosis associated with multiple cranial nerve palsy and subsequent subarachnoid hemorrhage].

    Science.gov (United States)

    Kikuchi, H; Kinoshita, Y; Arima, K; Doh-ura, K; Hisatomi, Y; Hashimoto, T; Sakai, H; Nawata, H; Iwaki, T

    1998-03-01

    We report an autopsy case of 53-year-old male with poor controlled diabetes mellitus and hepatocellular carcinoma who developed rhino-orbito-cerebral mucormycosis. Initial complaints were epistaxis and headache followed by a sudden blindness, the 2nd through 7th cranial nerve palsy and diabetes inspidus. Laboratory data revealed that he had liver cirrhosis due to hepatitis C virus infection and diabetes mellitus. Head CT and MRI showed no significant findings. Eleven days after the onset, he died of subarachnoid hemorrhage. The postmortem examination revealed severe infiltration of numerous mucors in the sphenoid sinus, cavernous sinus and bilateral internal carotid arteries. Severe granulomatous vasculitis was seen in the cavernous portion of the bilateral internal carotid arteries. Thus, we considered that this case had been caused by the infiltration of mucors to the cavernous sinus, resulting in the obstruction of ophthalmic arteries. Rupture of the right internal carotid artery was seen at the branching portion of the ophthalmic artery, demonstrating the cause of his death. We would like to emphasize that rhino-orbito-cerebral mucormycosis should be ruled out if we examine a nondiagnostic case of diabetes mellitus or immunosuppressed disease associated with rapid multiple cranial nerve palsy following the orbital symptoms. PMID:9711124

  11. No difference in the prevalence of benign breast changes between women from Ghana and Norway: an autopsy study.

    Science.gov (United States)

    Stalsberg, Helge; Adjei, Ernest Kwasi; Owusu-Afriyie, Osei

    2015-05-01

    Breast carcinoma develops gradually through multiple steps, some of which are recognizable as benign or premalignant histological changes. The age-standardized breast-cancer incidence rate is three times higher in Norway than in Ghana. A similar difference in the prevalence of benign and premalignant breast changes in the general populations would be expected if the difference in incidence rates were mainly due to cancer initiation factors, but not if it were caused by later stage promotion and progression factors. Breast tissue was taken by a standardized protocol from the autopsies of 44 Ghanaian and 26 Norwegian women between 15 and 60 years of age. Blind-labelled hematoxylin and eosin stained sections were examined independently by each of the three authors and the occurrence of histological changes in each section was recorded. The study revealed no significant difference between Norwegian and Ghanaian women in the prevalence of either proliferative or non-proliferative breast changes. The recorded incidence of breast cancer in Ghana may be under-estimated because of lower access to health services, lower patient awareness, and absence of population screening for breast cancer. Otherwise, the results support the conclusion that the lower incidence of breast cancer in Ghana than in Norway is mainly due to late-stage promotion and progression rather than initiation factors. PMID:25893589

  12. Presenile dementia mimicking Pick's disease: an autopsy case of localized amygdala degeneration with character change and emotional disorder.

    Science.gov (United States)

    Shibuya-Tayoshi, Sumiko; Tsuchiya, Kuniaki; Seki, Yukako; Arai, Tetsuaki; Kasahara, Toshihiko

    2005-09-01

    This report concerns an autopsy case showing localized amygdala degeneration. The patient was a Japanese single woman without hereditary burden who was 58 years old at the time of death. At the age of 55 years, the patient began to feel anxiety, agitation and depressive in mood. At age 58 years, she developed marked character changes and emotional disorders, although disorientation and memory disturbance were slight. We suspected her disease was a variant of presenile dementia, especially Pick's disease, and some neuroradiological examinations disclosed bilateral temporal involvements. We could not make a definitive diagnosis from the clinical findings. She choked to death 3 years after the disease onset. From the neuropathological examinations, the known neurodegenerative diseases causing dementia, including Pick's disease, were excluded and we diagnosed our case as having localized amygdala degeneration. Localized amygdala degeneration itself is very rare. Moreover, in this case, the amygdala degeneration was presumed to be idiopathic, without any apparent cause. To our knowledge, this is the first case of idiopathic localized amygdala degeneration. This case indicates that localized amygdala degeneration can cause presenile dementia, and that character changes and emotional disorders are predominant over memory disturbance and/or disorientation. PMID:16193841

  13. Patient and surgery related factors associated with fatigue type polyethylene wear on 49 PCA and DURACON retrievals at autopsy and revision

    Directory of Open Access Journals (Sweden)

    Ochsner Peter E

    2008-02-01

    Full Text Available Abstract Background Polyethylene wear is an important factor for longevity of total knee arthroplasty. Proven and suspicious factors causing wear can be grouped as material, patient and surgery related. There are more studies correlating design and/or biomaterial factors to in vivo wear than those to patient and surgery related factors. Many retrieval studies just include revision implants and therefore may not be representative. This study is aimed to correlate patient- and surgery- related factors to visual wear score by minimizing design influence and include both autopsy and revision implants. Comparison between the groups was expected to unmask patient and surgery-related factors responsible for wear. Methods The amount of joint side wear on polyethylene retrievals was measured using a modification of an established visual wear score. Fatigue type wear was defined as summation of the most severe wear modes of delamination, pitting and cracks. Analysis of patient and surgery related variables suspicious to cause wear included prospectively sampled patient activity which was measured by self reported walking capacity. Statistical analysis was done by univariate analysis of variance. Activity level and implantation time were merged to an index of use and correlated to the wear score. Results Wear score after comparable implantation time was significantly less in the autopsy group. Even so, fatigue type wear accounted for 84 and 93 % of total wear score on autopsy and revision implants respectively. A highly significant influence on wear score was found in time of implantation (p = 0.002, level of activity (p = 0.025 and inserts belonging to revision group (p = 0.006. No influence was found for the kind of patella replacement (p = 0.483. Body mass index and accuracy of component alignment had no significant influence on visual wear score. Fatigue-type wear in the medial compartment was closely correlated to the index of use in the autopsy (R2 = 0.383 and the revision group (R2 = 0.813. Conclusion The present study's finding of substantial fatigue type wear in both autopsy and revision retrievals supports the theory that polyethylene fatigue strength is generally exceeded in this type of prosthesis. Furthermore, this study correlated fatigue-type polyethylene wear to an index of use as calculated by activity over time. Future retrieval studies may use activity over time as an important patient related factor correlated to the visual wear score. When evaluating total knee arthroplasty routine follow up, the surgeon must think of substantial wear present even without major clinical signs.

  14. Cerebral and cardiac amyloidosis in autopsied elderly individuals / Beta-fibrilose encefálica e cardíaca em idosos autopsiados

    Scientific Electronic Library Online (English)

    Lucas Martins de Exel, Nunes; Ana Karina Marques, Salge; Flávia Aparecida de, Oliveira; Vicente de Paula A., Teixeira; Marlene Antônia dos, Reis.

    2006-04-01

    Full Text Available RESUMO INTRODUÇÃO: A amiloidose em idosos pode ser uma alteração independente e própria do envelhecimento. Entretanto, as características clínicas, fisiopatológicas e bioquímicas da Amiloidose relacionada à idade ainda permanecem incertas. OBJETIVO: Verificar se o coração e o encéfalo de indivíduos [...] acima de 60 anos apresentavam depósito amilóide. MATERIAL E MÉTODOS: Foram estudados laudos consecutivos de autópsias de indivíduos acima de 60 anos realizadas entre 1976 e 2000, que apresentavam corações sem cardiopatias, com sorologia negativa para Doença de Chagas e encéfalos sem alterações morfológicas de encefalopatias, chegando a um n de 10 casos. Lâminas de fragmentos do coração e de encéfalo foram processadas e analisadas em microscopia de luz comum e polarizada. RESULTADOS: Dos 10 casos, 3 apresentaram depósito amilóide no encéfalo e 1 no encéfalo e no coração. Em 50% dos casos, os indivíduos tinham entre 60 e 69 anos. A relação entre o peso encefálico e o peso corporal mostrou ter uma associação significativa com os casos positivos, sendo esta menor em relação aos negativos. CONCLUSÃO: A análise conjunta de depósitos amilóides em encéfalo e coração de indivíduos idosos talvez direcione para um acometimento sistêmico comum ao envelhecimento natural. Alguma alteração adicional do organismo poderia determinar a quebra de um equilíbrio natural sobre o acúmulo dessas proteínas, levando dessa forma aos contextos patológicos da amiloidose. Abstract in english INTRODUCTION: Amyloidosis in elderly individuals can be an independent alteration and a characteristic of aging. However, the clinical, pathophysiologic, and biochemical characteristics of amyloidosis related to age remain uncertain. OBJECTIVE: The purpose of this study was to determine the extent t [...] o which the heart and/or the brain of individuals aged 60 years or over exhibits amyloid deposits. MATERIALS AND METHODS: The autopsy findings of individuals who were at least 60 years old were studied. The autopsies took place between the years of 1976 and 2000. A total of 10 cases were selected that had hearts without cardiopathies, had negative serology for Chagas' disease, and had brains without morphological changes related to encephalopathies. Slides with fragments of heart and brain were processed and analyzed using polarized and common light microscopy. RESULTS: Of the 10 cases, 4 were positive for amyloidosis. All had positive findings in the brain, and 1 case also had positive findings in the heart. Among the positive cases, 50% were of people aged 60 to 69 years. There appeared to be a relationship between the presence of amyloid deposits and the ratio of brain and body weight, with the ratio in the positive cases being smaller than in the negative cases. CONCLUSIONS: The analysis of amyloid deposits in the brains and hearts of elderly individuals shows that such deposits may lead to a systemic attack of senility, common to natural aging. It is not certain that beta-amyloid deposits would alone bring such drastic repercussions to the individual. Some additional disorders of the organism could cause the breakdown of the natural balance related to the accumulation of these proteins, leading the way to the pathological contexts of amyloidosis.

  15. Cerebral and cardiac amyloidosis in autopsied elderly individuals Beta-fibrilose encefálica e cardíaca em idosos autopsiados

    Directory of Open Access Journals (Sweden)

    Lucas Martins de Exel Nunes

    2006-04-01

    Full Text Available INTRODUCTION: Amyloidosis in elderly individuals can be an independent alteration and a characteristic of aging. However, the clinical, pathophysiologic, and biochemical characteristics of amyloidosis related to age remain uncertain. OBJECTIVE: The purpose of this study was to determine the extent to which the heart and/or the brain of individuals aged 60 years or over exhibits amyloid deposits. MATERIALS AND METHODS: The autopsy findings of individuals who were at least 60 years old were studied. The autopsies took place between the years of 1976 and 2000. A total of 10 cases were selected that had hearts without cardiopathies, had negative serology for Chagas' disease, and had brains without morphological changes related to encephalopathies. Slides with fragments of heart and brain were processed and analyzed using polarized and common light microscopy. RESULTS: Of the 10 cases, 4 were positive for amyloidosis. All had positive findings in the brain, and 1 case also had positive findings in the heart. Among the positive cases, 50% were of people aged 60 to 69 years. There appeared to be a relationship between the presence of amyloid deposits and the ratio of brain and body weight, with the ratio in the positive cases being smaller than in the negative cases. CONCLUSIONS: The analysis of amyloid deposits in the brains and hearts of elderly individuals shows that such deposits may lead to a systemic attack of senility, common to natural aging. It is not certain that beta-amyloid deposits would alone bring such drastic repercussions to the individual. Some additional disorders of the organism could cause the breakdown of the natural balance related to the accumulation of these proteins, leading the way to the pathological contexts of amyloidosis.RESUMO INTRODUÇÃO: A amiloidose em idosos pode ser uma alteração independente e própria do envelhecimento. Entretanto, as características clínicas, fisiopatológicas e bioquímicas da Amiloidose relacionada à idade ainda permanecem incertas. OBJETIVO: Verificar se o coração e o encéfalo de indivíduos acima de 60 anos apresentavam depósito amilóide. MATERIAL E MÉTODOS: Foram estudados laudos consecutivos de autópsias de indivíduos acima de 60 anos realizadas entre 1976 e 2000, que apresentavam corações sem cardiopatias, com sorologia negativa para Doença de Chagas e encéfalos sem alterações morfológicas de encefalopatias, chegando a um n de 10 casos. Lâminas de fragmentos do coração e de encéfalo foram processadas e analisadas em microscopia de luz comum e polarizada. RESULTADOS: Dos 10 casos, 3 apresentaram depósito amilóide no encéfalo e 1 no encéfalo e no coração. Em 50% dos casos, os indivíduos tinham entre 60 e 69 anos. A relação entre o peso encefálico e o peso corporal mostrou ter uma associação significativa com os casos positivos, sendo esta menor em relação aos negativos. CONCLUSÃO: A análise conjunta de depósitos amilóides em encéfalo e coração de indivíduos idosos talvez direcione para um acometimento sistêmico comum ao envelhecimento natural. Alguma alteração adicional do organismo poderia determinar a quebra de um equilíbrio natural sobre o acúmulo dessas proteínas, levando dessa forma aos contextos patológicos da amiloidose.

  16. Determining the morphometry and variations of the confluens sinuum and related structures via a silicone painting technique on autopsy patients.

    Science.gov (United States)

    Cosar, Murat; Seker, Askn; Ceylan, Davut; Tatarli, Necati; Sahin, Fevzi; Tokmak, Mehmet; Songur, Ahmet; Kilic, Turker; Ozen, Oguz Aslan

    2014-11-01

    In this study, we aimed to investigate the morphometric and morphologic structures of the confluens sinuum (CS) and related structures with a silicone painting technique. We studied 30 cadavers. Twelve of them were washed with alcohol and filled with a silicone painting technique via the vena jugularis interna, internal carotid artery, and vertebral artery. The other 18 were autopsied postmortem. The CS and related structures were dissected under microscope. Their anatomy was investigated, and variations were noted. The diameters of the sinus sagittalis superior (SSS), CS, occipital sinus (OS), sinus rectus (SR), and bilateral transverse sinus (TS), and the angle between SSS and SR were measured. The mean diameters were 11.7 mm for SSS, 22.3 mm for CS, 5.25 mm for OS, 7.5 mm for SR, and 9.7 (right) and 9.1 mm (left) for TS. The angle between the SR and SSS was 58°. There was no difference in the bilateral venous structures that drained to the SSS and TS. There was an extra drainage to the CS from the left side in 4 cases. The right TS was located superiorly in 7 cases compared with the left TS, and this process was correlated with the type of CS. A septum in the SSS was detected in 2 cases. In addition, we encountered an OS in 80% of the cases. We conclude that the septum inside the CS affects the dominancy of the TS, the angle between the SSS and SR, and the other venous variations. PMID:24448535

  17. Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies

    Directory of Open Access Journals (Sweden)

    Desta Teklay

    2007-02-01

    Full Text Available Abstract Background Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5, thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and service settings where levels and changes in pregnancy-related deaths need to be measured, for example in assessing progress towards MDG-5.

  18. Suicidio y género en Antioquia (Colombia): estudio de autopsia psicológica / Suicide and Gender in Antioquia (Colombia): A Psychological Autopsy Study

    Scientific Electronic Library Online (English)

    Andrea, González; Ángela, Rodríguez Betancur; Alejandro, Aristizábal; Jenny, García Valencia; Carlos, Palacio; Carlos, López Jaramillo.

    2010-06-01

    Full Text Available Objetivo: Identificar diferencias en las características sociodemográficas y clínicas entre hombres y mujeres suicidas en una muestra de Antioquia (Colombia). Método: Se estudiaron mediante autopsia psicológica 144 sujetos que se habían suicidado entre 2006 y 2007. Se determinaron las diferencias en [...] tre suicidas por sexos y las características que se asociaron de manera independiente con ser hombre o mujer. Resultados: Se identificaron diferencias significativas independientes del sexo. La manera de muerte con arma de fuego, vivir solo y suicidio bajo efectos del alcohol se asociaron con el sexo masculino; mientras, el suicidio en casa y dejar una nota previa se asociaron con el sexo femenino. Conclusiones: El presente estudio, realizado en población antioqueña, identificó diferencias en variables sociodemográficas, clínicas y características del acto suicida entre hombres y mujeres. A Zesar de las limitaciones, los presentes hallazgos apuntan hacia la posibilidad de realizar intervenciones de salud mental de prevención del suicidio de mayor especificidad teniendo en cuenta el sexo de la población. Abstract in english Objective: To identify differences in the socio-demographic and clinical characteristics between suicidal men and women in a sample from Antioquia (Colombia). Method: 144 subjects who committed suicide between 2006 and 2007 were studied by means of a psychological autopsy. Gender differences and cha [...] racteristics associated independently to being a man or a woman were determined. Results: Significant differences independent of sex were identified. Death by firearm, living alone and suicide under the effects of alcohol intoxication were associated with the male gender, whereas suicide at home and leaving a note were associated with the female gender. Conclusions: The present study identified differences in socio-demographic and clinical variables, and characteristics of the suicide act, between men and women. In spite of its limitations, the present findings point towards the possibility of carrying out more specific actions in suicide prevention by taking gender into account.

  19. Combining diagnostic categories to improve agreement between death certificate and autopsy classifications of cause of death for atomic bomb survivors, 1950-87

    International Nuclear Information System (INIS)

    Several investigators have observed less-than-desirable agreement between death certificate diagnoses and autopsy diagnoses for most specific causes of death, and even for some causes grouped by major disease category. Our results from data on 5130 autopsies of members of the Life Span Study cohort of atomic bomb survivors in Hiroshima and Nagasaki conducted prior to September 1987 were equally discouraging. Among diseases with more than 10 cases observed, confirmation rates ranged from 13 % to 97 % and detection rates from 6 % to 90 %. Both rates were greater than 70 % for only 6 of 60 disease categories studied and for only 1 of 16 categories defined by major International Classification of Disease categories (neoplasms). This deficiency suggests cautious interpretation of results from studies based on death certificate diagnoses. To determine whether any groupings of diagnoses might meet acceptable accuracy requirements, we applied a hierarchical clustering method to data from these 5130 cohort members. The resulting classification system had 10 categories: breast cancer; other female cancers; cancers of the digestive organs; cancer of the larynx; leukemia; nasal, ear, or sinus cancer; tongue cancer; external causes; vascular disease; and all other causes. Confirmation and detection rates for each of these categories were at least 66 %. Although the categories are broad, particularly for nonneoplastic diseases, further divisions led to unacceptable accuracy rates for some of the resulting diagnostic groups. Using the derived classification system, there was 72 % agreement overall between death certificate and autopsy diagnoses compared to 53 % agreement for a second system obtained by grouping strictly by major disease category. Eighty-seven percent agreement was observed for a similar classification system with vascular disease grouped with all other nonneoplastic diseases. Further agglomeration achieved very little additional improvement. (J.P.N.)

  20. Effect of metallothionein core promoter region polymorphism on cadmium, zinc and copper levels in autopsy kidney tissues from a Turkish population

    International Nuclear Information System (INIS)

    Metallothioneins (MTs) are metal-binding, low molecular weight proteins and are involved in pathophysiological processes like metabolism of essential metals, metal ion homeostasis and detoxification of heavy metals. Metallothionein expression is induced by various heavy metals especially cadmium, mercury and zinc; MTs suppress toxicity of heavy metals by binding themselves to these metals. The aim of this study was to investigate the association between the - 5 A/G metallothionein 2A (MT2A) single nucleotide polymorphism (SNP) and Cd, Zn and Cu levels in the renal cortex from autopsy cases. MT2A core promoter region - 5 A/G SNP was analyzed by PCR-RFLP method using 114 autopsy kidney tissues and the genotype frequencies of this polymorphism were found as 87.7% homozygote typical (AA), 11.4% heterozygote (AG) and 0.9% homozygote atypical (GG). In order to assess the Cd, Zn and Cu levels in the same autopsy kidney tissues, a dual atomic absorption spectrophotometer system was used and the average levels of Cd, Zn and Cu were measured as 95.54 ± 65.58 ?g/g, 181.20 ± 87.72 ?g/g and 17.14 ± 16.28 ?g/g, respectively. As a result, no statistical association was found between the - 5 A/G SNP in the MT2A gene and the Zn and Cu levels in the renal cortex (p > 0.05), but considerably high accumulation of Cd was monitored for individuals having AG (151.24 ± 60.21 ?g/g) and GG genotypes (153.09 ?g/g) compared with individuals having AA genotype (87.72 ± 62.98 ?g/g) (p < otype (87.72 ± 62.98 ?g/g) (p < 0.05). These results show that the core promoter region polymorphism of metallothionein 2A increases the accumulation of Cd in human renal cortex.

  1. Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias / Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study

    Scientific Electronic Library Online (English)

    Hugo Hyung, Bok Yoo; Fabiana Guandalini, Mendes; Christine Elisabete Rubio, Alem; Alexandre Todorovic, Fabro; José Eduardo, Corrente; Thais Thomaz, Queluz.

    2004-10-01

    Full Text Available INTRODUÇÃO: Tromboembolia pulmonar (TEP) é ainda uma afecção enigmática em diversos aspectos clínicos e epidemiológicos e frequentemente erroneamente diagnosticada. OBJETIVO: Descrever a prevalência e os achados anatomopatológicos de TEP em uma série de 5261 autópsias realizadas em um hospital unive [...] rsitário de nível terciário, correlacionar estes achados com as doenças de base e verificar a freqüência de suspeita clínica antemortem de TEP. MÉTODO: Revisão dos registros das autópsias consecutivas realizadas de 1979 a 2002 para um estudo retrospectivo. Dos prontuários e dos relatórios de autópsias dos pacientes que tiveram TEP documentada, macro e/ou microscopicamente, foram extraídos dados demográficos, doenças de base, suspeita antemortem de TEP, localização dos trombos nos pulmões e provável local de origem da TEP. RESULTADOS: A freqüência de autópsias foi de 42,0% e TEP foi encontrada em 544 pacientes, sendo a principal causa da morte (TEP fatal) em 225 casos. Doenças infecciosas (p=0,0003) foram associadas com TEP não fatal e trauma (p=0,007) com TEP fatal. A taxa de não suspeita antemortem de TEP foi 84,6% e 40,0% destes pacientes apresentaram TEP fatal. Doenças do sistema circulatório (p=0,0001), infecções (p Abstract in english BACKGROUND: Pulmonary thromboembolism (PTE) is still an enigmatic disorder in many epidemiological and clinical features, remaining one of the most commonly misdiagnosed disorders. OBJECTIVE: To describe the prevalence and pathological findings of PTE in a series of autopsies, to correlate these fin [...] dings with underlying diseases, and to verify the frequency of PTE clinically suspected before death. METHOD: The reports on 5261 consecutive autopsies performed from 1979 to 2002 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the patients found with macroscopically and/or microscopically documented PTE, were gathered data on demographics, underlying diseases, antemortem suspicion of PTE, and probable PTE site of origin. RESULTS: The autopsy rate was 42.0% and PTE was found in 544 patients. In 225 cases, PTE was the main cause of death (fatal PTE). Infections (p=0.0003) were associated with nonfatal PTE and trauma (p=0.007) with fatal PTE. The rate of antemortem unsuspected PTE was 84.6% and 40.0% of these patients presented fatal PTE. Diseases of the circulatory system (p=0.0001), infections (p

  2. Autopsias realizadas en el Hospital "Dr. Luis Díaz Soto" de 1962 a 1995 / Autopsies performed at "Dr. Luis Diaz Soto" hospital from 1962 to 1995

    Scientific Electronic Library Online (English)

    José, Hurtado de Mendoza Amat; Reynaldo, Álvarez Santana; Verónica, Walwyn Salas; Teresita de Jesús, Montero González; Roberto, Carriles Martínez-Pinillos; Jesús, Rodríguez Guerra.

    1997-12-01

    Full Text Available Para conocer la información fundamental contenida en el banco de datos de autopsias realizadas en el Hospital "Dr Luis Díaz Soto", creado mediante el Sistema Automatizado de Registo y Control de Anatomía Patológica, se procesaron las 10 099 autopsias realizadas entre diciembre de 1962 y diciembre de [...] 1995, y de ellas se estudiaron en particular 7 886 de adultos. El sexo masculino predominó, así como el grupo de edad de 65-74 años. Medicina Interna, Terapia Intensiva y Medicina de Urgencia fueron las especialidades de egreso más representadas. Las principales causas básicas de muerte fueron los trastornos cardiovasculares, en especial aterosclerosis, y los tumores malignos, y en partícular el cáncer del pulmón. Sus complicaciones se correspondieron con las principales causas directas e intermedias de muerte. En general, los trastornos cardiovasculares, las infecciones, los tumores malignos y el daño multiorgánico constituyeron los grupos de trastornos de mayor trascendencia tanto como causa de muerte como en la morbilidad asociada. Entre 1987 y 1995 hubo el 32,6 % de discrepancias diagnósticas pre y postmortem en causas básicas de muerte y 28,5 % en causas directas e intermedias de muerte. Se destacó la importancia del estudio de las causas directas e intermedias de muerte (multicausalidad), la evaluación de la calidad de los diagnósticos premortem y la utilidad de la creación de un banco de datos de autopsias para continuar este estudio. Abstract in english A number of 10 099 autopsies performed between December, 1962 and December, 1985 were processed in order to know the main information contained in the databank of autopsies performed at "Dr: Luis Díaz Soto"hospital, created by the Automated System of Register and Control of Pathologic Anatomy. Of th [...] ese autopsies 7 886 of adult subjects were studied in particular. Male sex predominated, as well as the 65-74 years old age group. The most represented specialties were Internal Medicine, Intensive Therapy, and Emergency Medicine. The principal basic causes of death were cardiovascular disorders, especially atherosclerosis, and malignant tumors, particularly lung cancer. The complications were in agreement with the principal direct or intermediate causes of death. In general, cardiovascular disorders, infections, malignant tumors, and multiorgan damage constituted the groups with a higher frequency as a cause of death in associated morbidity. Between 1987 and 1995 there was a 32.6% of diagnostic discrepancies regarding the basic causes of death and 28.5% with respect to direct or intermediate causes of death. The importance of the study the direct and intermediate causes of death (multicausality),the evaluation of the quality of premorten diagnosis, and the usefulness of the creation of an autopsy databank were higlighted in order to continue this study.

  3. 13Carbon and 15Nitrogen isotopes in autopsy liver tissue samples from Greenlandic Inuit and Danes: consumption of marine versus terrestrial food

    OpenAIRE

    Milman, Nils; Laursen, Jens; Mulvad, Gert; Pedersen, Henning; Pedersen, Agnes; Saaby, Henrik

    2010-01-01

    Abstract Background: 13C and 15N isotopes in human tissue reflects the relative proportions of marine and terrestrial food consumed by the individual. Objective: To measure 13C and 15N in liver tissue from Greenlandic Inuit and Danes Methods: Liver tissue was obtained at autopsy in 1992-1994 from 60 Inuit (median age 61 y) and in 1986 from 15 Danes (median age 84 y). By sieving, liver tissue was separated in a "cellular fraction" and a "connective tissue fraction". 13C and 15...

  4. Organ distribution of radioactive cesium in autopsy material following the Chernobyl catastrophe. Die Organverteilung von radioaktivem Caesium im Obduktionsmaterial nach der Tschernobyl-Katastrophe

    Energy Technology Data Exchange (ETDEWEB)

    Bankl, H. (Krankenhaus St. Poelten (Germany, F.R.). Inst. fuer Pathologie); Dam, K. (Krankenhaus St. Poelten (Germany, F.R.). Nuklearmedizinische Station)

    1987-07-01

    Tissue specimens were obtained at autopsy, mechanically reduced to small pieces and filled into test tubes up to a height of 5 cm so that the measuring requirements were compatible with the maximum counting efficiency of the device used. Such tissue examinations were performed for the skeletal musculature of the calf, the liver, spleen, kidneys, heart muscle, thyroid, testicles, brain, fatty tissue from the abdominal wall as well as bone marrow from the femur. On separate quantitative analysis is was found that 67% of the cesium currently detected in tissue samples is Cs-137, while Cs-134 accounts for no more than 33%. (orig./DG).

  5. Expansion of the Multi-Link Frontier™ Coronary Bifurcation Stent: Micro-Computed Tomographic Assessment in Human Autopsy and Porcine Heart Samples

    Science.gov (United States)

    Kralev, Stefan; Haag, Benjamin; Spannenberger, Jens; Lang, Siegfried; Brockmann, Marc A.; Bartling, Soenke; Marx, Alexander; Haase, Karl-Konstantin; Borggrefe, Martin; Süselbeck, Tim

    2011-01-01

    Background Treatment of coronary bifurcation lesions remains challenging, beyond the introduction of drug eluting stents. Dedicated stent systems are available to improve the technical approach to the treatment of these lesions. However dedicated stent systems have so far not reduced the incidence of stent restenosis. The aim of this study was to assess the expansion of the Multi-Link (ML) Frontier™ stent in human and porcine coronary arteries to provide the cardiologist with useful in-vitro information for stent implantation and selection. Methodology/Principal Findings Nine ML Frontier™ stents were implanted in seven human autopsy heart samples with known coronary artery disease and five ML Frontier™ stents were implanted in five porcine hearts. Proximal, distal and side branch diameters (PD, DD, SBD, respectively), corresponding opening areas (PA, DA, SBA) and the mean stent length (L) were assessed by micro-computed tomography (micro-CT). PD and PA were significantly smaller in human autopsy heart samples than in porcine heart samples (3.54±0.47 mm vs. 4.04±0.22 mm, p?=?0.048; 10.00±2.42 mm2 vs. 12.84±1.38 mm2, p?=?0.034, respectively) and than those given by the manufacturer (3.54±0.47 mm vs. 4.03 mm, p?=?0.014). L was smaller in human autopsy heart samples than in porcine heart samples, although data did not reach significance (16.66±1.30 mm vs. 17.30±0.51 mm, p?=?0.32), and significantly smaller than that given by the manufacturer (16.66±1.30 mm vs. 18 mm, p?=?0.015). Conclusions/Significance Micro-CT is a feasible tool for exact surveying of dedicated stent systems and could make a contribution to the development of these devices. The proximal diameter and proximal area of the stent system were considerably smaller in human autopsy heart samples than in porcine heart samples and than those given by the manufacturer. Special consideration should be given to the stent deployment procedure (and to the follow-up) of dedicated stent systems, considering final intravascular ultrasound or optical coherence tomography to visualize (and if necessary optimize) stent expansion. PMID:21814552

  6. Coma and death in unrecognized wernicke's encephalopathy an autopsy study: estudo necroscópico / Coma e morte na encefalopatia de Wernioke

    Scientific Electronic Library Online (English)

    Marco Aurélio, Lana-peixoto; Eustáquio Claret Dos, Santos; José Eymard H., Pittella.

    1992-09-01

    Full Text Available Numa série de 36 casos de encefalopatia de Wernicke autopsiados, 11 haviam desenvolvido coma. Em nenhum desses pacientes comatosos o diagnóstico foi estabelecido durante a vida. Seis desses pacientes eram homens e 5 mulheres, com idades entre 26 a 50 anos (média de 36,6). História de alcoolismo crôn [...] ico foi positiva em 7 casos, sinais de desnutrição grave ocorreram em 3; uma paciente (apresentava câncer gástrico e uma, hiper emese gravídica. Dois pacientes foram admitidos ao hospital após terem sido encontrados em coma em suas residências. O exame neuropatológieo revelou alterações macroscópicas nos corpos mamilares em 8 casos - atrofia, descoloração e espongiose. Atrofia da porção anterior e superior do vermis do cerebelo foi observada em um caso. Era 5 casos havia hemorragias petequiais no diencéfalo, principalmente próximas às paredes do terceiro ventrículo. A microscopia revelou além das hemorragias, proliferação glial, hipertrofia do endotélio vascular e necrose de neurônios e mielina. Mielinólise pontina central ocorreu em um paciente. A encefalopatia de Wernicke é pouco diagnosticada clinicamente. O coma pode mascarar as outras manifestações clínicas da doença ou pode constituir sua única manifestação. Embora seja um sinal de mau prognóstico, o coma pode ser revertido pela administração de tiamina. É enfatizado que todo paciente em coma de causa não estabelecida deve receber altas doses de tiamina. Abstract in english Eleven out of 36 autopsied cases of Wernicke's encephalopathy had developed coma. None of these patients had the diagnosis during life. There were six men and five women with ages ranging from 36 to 50 years (mean 36.6). Seven of these patients were heavy drinkers, three exhibited signs of severe ma [...] lnutrition, whereas one was being evaluated for a disseminated gastric cancer and one was in treatment of hyperemesis gravidarum. Two patients were brought to the hospital after found unconscious at home. Neuropatholo-gical examination disclosed gross changes in the mammillary bodies in eight cases and microscopic changes in all cases. In one case there was atrophy of the anterior superior part of the vermis. Petechial hemorrhages were observed particularly in the walls of the third ventricle. Microscopically there were in addition to hemorrhages, glial proliferation, endothelial hypertrophy and necrosis of nerve cells and myelin. Central pontine myelmolysis was observed in one case. Wernicke's encephalopathy is a clinically underdiagnosed condition. Coma may mask its classical clinical picture or even be the sole manifestation. Although coma points to a poor outlook it may be reversed by thiamine administration. Any patient with Coma of unknown etiology should be given parenteral thiamine.

  7. A report of two cases: post flood autopsy findings in urban patients with an unusual presentation of leptospirosis with hemorrhagic pneumonia in government medical college, Surat

    Directory of Open Access Journals (Sweden)

    Mandakini M Patel, Bhavna Gamit, R D Patel, Rahul Modi

    2011-01-01

    Full Text Available South Gujarat is endemic zone for leptospirosis in paddy workers but recently we have post flood plenty of urban patients who were presented with high grade fever, dyspnea & haemoptysis with rapid deterioration. Clinicians were suspecting an outbreak of Hantavirus or leptospirosis. Both our patients were serologically negative for leptospirosis ante mortem, but alveolar hemorrhage & raised urea was the only finding. Both our patient rapidly deteriorated. We performed autopsy & took post mortem samples for serologically & HP Examination of tissue. Serological finding showed one patient positive for PCR and second was positive for Leptocheck and IgM ELISA. On HP examination we observed massive intra-alveolar hemorrhage, interstitial nephritis, vasculitis in spleen and kidney, myocarditis & hemorrhage in various organs like heart, suprarenal gland, and subarachnoid space in both our patient. Levaditi’s stain was also performed but results were not conclusive. IHC for kidney tissue was not possible due to lack of facility. Extensive hemorrhage in lung was the cause of death in both patients. Follow up autopsy studies of 30 patients were showing same histopathological findings.

  8. Necropsia e mortalidade por causa mal definida no Estado de São Paulo, Brasil Autopsy and ill-defined cause of death in the state of São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Abrahão Rozman

    2006-11-01

    Full Text Available OBJETIVO: Investigar a proporção de mortes por causa mal definida no Estado de São Paulo entre 1980 e 2002, considerando a influência da realização de necropsia nessa proporção. MÉTODO: O número de óbitos foi obtido do Ministério da Saúde. Dividiu-se o Estado de São Paulo em três áreas: 1 municípios com serviço de verificação de óbitos (SVO, que pode realizar necropsias; 2 municípios sem SVO; e 3 Baixada Santista, região onde houve um aumento marcante na proporção de mortes por causa mal definida entre 1980 e 1995. O impacto das necropsias na proporção de óbitos por causa mal definida foi medido com base na classificação da causa de óbito pelo primeiro médico avaliador (aquele que encaminhou o caso para o SVO para necropsia ou que preencheu a declaração de óbito sem encaminhar o caso. Os óbitos por causas externas foram excluídos por ter necropsia obrigatória. Foram avaliadas as proporções 1 de casos classificados como de causa mal definida pelo primeiro avaliador; 2 de necropsias no total de óbitos excluindo causas externas; e 3 de óbitos com causa esclarecida por necropsia entre os classificados como de causa mal definida pelo primeiro avaliador. RESULTADOS: A proporção de óbitos classificados como de causa mal definida pelo primeiro avaliador aumentou entre 1980 e 2002 em todas as áreas: nos municípios com SVO, nos municípios sem SVO e na Baixada Santista. Para o Estado de São Paulo como um todo, o aumento foi de quase 30% no período de 1980 a 2002. Para o período de 1998 a 2002, a proporção média de necropsias no total de óbitos excluindo causas externas foi de 21,2, 6,4 e 2,6%, respectivamente, nas áreas com e sem SVO e na Baixada Santista. Entre 1998 e 2002, a proporção de óbitos com causa mal definida esclarecidos pela necropsia foi de 92,9 nas áreas com SVO, 32,5 nas áreas sem SVO e 10,7% na Baixada Santista. CONCLUSÕES: A realização de necropsias explica a diferença na mortalidade proporcional por causa mal definida entre as áreas estudadas. O aumento observado entre 1980 e 2002 na classificação de óbitos por causa mal definida pelo primeiro avaliador no Estado de São Paulo indica uma importante piora na qualidade do preenchimento da declaração de óbito nessa instância. São necessárias investigações adicionais para esclarecer as causas dessa mudança.OBJECTIVE: To investigate the proportion of deaths with an ill-defined cause in the Brazilian state of São Paulo between 1980 and 2002, taking into account the influence of autopsies on this proportion. METHOD: Data on the number of deaths were obtained from the Brazilian Ministry of Health. The communities of the state of São Paulo were divided into three groups: (1 municipalities with a service to verify the cause of death (and that may conduct an autopsy, (2 municipalities without a cause of death verification service, and (3 the region of Baixada Santista, which had an extremely large increase in the proportion of deaths from ill-defined causes between 1980 and 1995. The impact of autopsies on the proportion of deaths with an ill-defined cause was defined based on the classification made by the first physician evaluating the cause of death, that is, the physician who referred the case to the verification service for autopsy or who completed the death certificate without referring the case to the verification service. Deaths from external causes were excluded, since autopsy is mandatory in these cases. The following were evaluated: (1 proportion of cases classified by the first evaluating physician as having an ill-defined cause, (2 proportion of autopsies in relation to the total number of deaths (except from external causes, and (3 proportion of deaths classified as ill-defined by the first evaluating physician but explained by the autopsy. RESULTS: The proportion of deaths classified by the first evaluating physician as having an ill-defined cause increased over the 1980-2002 period in all three groups studied: the municipalities with a verification service, the

  9. An autopsy case of penetration of a sigmoid colon diverticulum with septic shock during the treatment of lung cancer-related pain.

    Science.gov (United States)

    Haga, Tomoaki; Shibahara, Hiroaki; Narita, Michihiko; Okubo, Kenji; Nishimura, Daisaku; Katada, Naoyuki

    2015-01-01

    A 70-year-old man presented with septic shock and abdominal pain during treatment of pain caused by stage IV lung adenocarcinoma. CT revealed air collection from the retroperitoneum to the muscle around the thigh. Septic shock due to retroperitoneal penetration from the digestive tract was suspected. Despite treatment attempts, the patient died. The autopsy diagnosis was penetration of a sigmoid colon diverticulum under the serosa. When a diverticulum is located near the mesenterium and the size of penetration is small, the air collection rather than fecal matter is likely to extend retroperitoneally. Abdominal pain is little manifest in the penetration in contrast to perforation into abdominal cavity, and the attention is needed. PMID:25748156

  10. Alterações histopatológicas pulmonares em pacientes com insuficiência respiratória aguda: um estudo em autopsias / Pulmonary histopathological alterations in patients with acute respiratory failure: an autopsy study

    Scientific Electronic Library Online (English)

    Alexandre de Matos, Soeiro; Edwin Roger, Parra; Mauro, Canzian; Cecília, Farhat; Vera Luiza, Capelozzi.

    2008-02-01

    Full Text Available OBJETIVOS: Apresentar alterações histopatológicas pulmonares encontradas em autopsias de pacientes falecidos por insuficiência respiratória aguda (IRA) e verificar se doenças de base e específicos fatores de risco associados aumentam a incidência dessas alterações. MÉTODOS: Foram revisados laudos fi [...] nais de autopsias e selecionadas 3.030 autopsias de pacientes > 1 ano de idade, com infiltrado pulmonar radiológico, portadores de doença de base e fatores de risco associados, que morreram por alterações pulmonares decorrentes de IRA. RESULTADOS: As principais alterações histopatológicas pulmonares causadoras de morte imediata foram: dano alveolar difuso (DAD); edema pulmonar; pneumonia intersticial linfocítica (PIL) e hemorragia alveolar. As principais doenças de base encontradas foram: AIDS; broncopneumonia; sepse; cirrose hepática; tromboembolismo pulmonar; infarto agudo do miocárdio (IAM); acidente vascular cerebral; tuberculose; câncer; insuficiência renal crônica e leucemia. Os principais fatores de risco associados foram: idade > 50 anos; hipertensão arterial; insuficiência cardíaca congestiva; doença pulmonar obstrutiva crônica e diabetes mellitus. Pacientes com esses fatores de risco e AIDS apresentaram alta probabilidade de desenvolver PIL; pacientes com esses mesmos fatores, de desenvolver DAD, se portadores de sepse ou cirrose hepática; pacientes com tromboembolismo e os mesmos fatores de risco, de desenvolver hemorragia alveolar; pacientes com esses fatores de risco e IAM, de desenvolver edema pulmonar. CONCLUSÕES: Os achados pulmonares em pacientes com óbito por IRA apresentaram quatro padrões histopatológicos: DAD, edema pulmonar, PIL e hemorragia alveolar. Doenças de base e específicos fatores de risco associados correlacionaram-se positivamente com determinados padrões histopatológicos detectados à autópsia. Abstract in english OBJECTIVE: To present the pulmonary histopathological alterations found in the autopsies of patients with acute respiratory failure (ARF) and determine whether underlying diseases and certain associated risk factors increase the incidence of these histopathological patterns. METHODS: Final autopsy r [...] eports were reviewed, and 3030 autopsies of patients > 1 year of age with an underlying disease and associated risk factors were selected. All had developed diffuse infiltrates and died of ARF-related pulmonary alterations. RESULTS: The principal pulmonary histopathological alterations resulting in immediate death were diffuse alveolar damage (DAD), pulmonary edema, lymphocytic interstitial pneumonia (LIP) and alveolar hemorrhage. The principal underlying diseases were AIDS, bronchopneumonia, sepsis, liver cirrhosis, pulmonary thromboembolism, acute myocardial infarction (AMI), cerebrovascular accident, tuberculosis, cancer, chronic kidney failure and leukemia. The principal associated risk factors were as follows: age > 50 years; arterial hypertension; congestive heart failure; chronic obstructive pulmonary disease; and diabetes mellitus. These risk factors and AIDS correlated with a high risk of developing LIP; these same risk factors, if concomitant with sepsis or liver cirrhosis, correlated with a risk of developing DAD; thromboembolism and these risk factors correlated with a risk of developing alveolar hemorrhage; these risk factors and AMI correlated with a risk of developing pulmonary edema. CONCLUSION: Pulmonary findings in patients who died of ARF presented four histopathological patterns: DAD, pulmonary edema, LIP and alveolar hemorrhage. Underlying diseases and certain associated risk factors correlated positively with specific histopathological findings on autopsy.

  11. Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study

    Directory of Open Access Journals (Sweden)

    Hugo Hyung Bok Yoo

    2004-10-01

    Full Text Available INTRODUÇÃO: Tromboembolia pulmonar (TEP é ainda uma afecção enigmática em diversos aspectos clínicos e epidemiológicos e frequentemente erroneamente diagnosticada. OBJETIVO: Descrever a prevalência e os achados anatomopatológicos de TEP em uma série de 5261 autópsias realizadas em um hospital universitário de nível terciário, correlacionar estes achados com as doenças de base e verificar a freqüência de suspeita clínica antemortem de TEP. MÉTODO: Revisão dos registros das autópsias consecutivas realizadas de 1979 a 2002 para um estudo retrospectivo. Dos prontuários e dos relatórios de autópsias dos pacientes que tiveram TEP documentada, macro e/ou microscopicamente, foram extraídos dados demográficos, doenças de base, suspeita antemortem de TEP, localização dos trombos nos pulmões e provável local de origem da TEP. RESULTADOS: A freqüência de autópsias foi de 42,0% e TEP foi encontrada em 544 pacientes, sendo a principal causa da morte (TEP fatal em 225 casos. Doenças infecciosas (p=0,0003 foram associadas com TEP não fatal e trauma (p=0,007 com TEP fatal. A taxa de não suspeita antemortem de TEP foi 84,6% e 40,0% destes pacientes apresentaram TEP fatal. Doenças do sistema circulatório (p=0,0001, infecções (pBACKGROUND: Pulmonary thromboembolism (PTE is still an enigmatic disorder in many epidemiological and clinical features, remaining one of the most commonly misdiagnosed disorders. OBJECTIVE: To describe the prevalence and pathological findings of PTE in a series of autopsies, to correlate these findings with underlying diseases, and to verify the frequency of PTE clinically suspected before death. METHOD: The reports on 5261 consecutive autopsies performed from 1979 to 2002 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the patients found with macroscopically and/or microscopically documented PTE, were gathered data on demographics, underlying diseases, antemortem suspicion of PTE, and probable PTE site of origin. RESULTS: The autopsy rate was 42.0% and PTE was found in 544 patients. In 225 cases, PTE was the main cause of death (fatal PTE. Infections (p=0.0003 were associated with nonfatal PTE and trauma (p=0.007 with fatal PTE. The rate of antemortem unsuspected PTE was 84.6% and 40.0% of these patients presented fatal PTE. Diseases of the circulatory system (p=0.0001, infections (p<0.0001, diseases of the digestive system (p=0.0001, neoplasia (p=0.024 and trauma (p=0.005 were associated with unsuspected PTE. The most frequent PTE site of origin was the lower limbs (48.9%. Probable PTE sites of origin such as right-sided cardiac chambers (p=0.012 and pelvic veins (p=0.015 were associated with fatal PTE. CONCLUSION: A large number of cases do not have antemortem suspicion of PTE. Special attention should be paid to the possibility of PTE in patients with diseases of the circulatory system, infections, diseases of the digestive system, neoplasia, and trauma.

  12. Levels of some trace elements in selected autopsy organs, and in hair and blood samples from adult subjects of the Italian population

    International Nuclear Information System (INIS)

    This study, which is part of a research program for the determination of trace element reference levels in various human tissues for the Italian population, presents the concentrations of Se, Hg, Cr, Cs, Sc, Rb, Zn, Fe, Co, and Sb in lung, liver, spleen, and kidney autopsy samples taken from 14 adult subjects of the Italian population who died from accidental causes. Concentrations of the same trace elements are given also for blood and hair samples taken from subjects of the general Italian population and of a population group living in a small coastal town that has an average annual fish consumption well above the national average. The analytical method used was Instrumental Neutron Activation Analysis. The levels and distribution of the trace elements in the various human organs examined are analyzed and discussed

  13. Agenesia de vena cava inferior en un caso de autopsia forense / Absence of the inferior cava vein in a case of forensic autopsy

    Scientific Electronic Library Online (English)

    M., Subirana Domènech; I., Galtés Vicente; G., Font Valsecchi; A., Xifró Collsamata.

    2011-06-01

    Full Text Available La agenesia de vena cava inferior es una entidad congénita poco frecuente que a menudo se asocia con otras severas anomalías congénitas o malposiciones viscerales. También ha sido descrita como un factor de riesgo de trombosis venosa en pacientes jóvenes. La mayoría de los casos publicados proceden [...] de estudios radiológicos y muy raramente aparece como hallazgo necrópsico. Presentamos un caso de agenesia de vena cava inferior, sin otras anomalías asociadas, que apareció como hallazgo incidental en una autopsia forense. Abstract in english The absence of the inferior vena cava is a rare congenital anomaly, often associated with severe congenital deformities and visceral position abnormalities. It has been described also as a risk factor for deep vein thrombosis in young patients. We present a case of congenital absence of inferior ven [...] a cava appeared as an incidental finding in a forensic autopsy.

  14. Agenesia de vena cava inferior en un caso de autopsia forense Absence of the inferior cava vein in a case of forensic autopsy

    Directory of Open Access Journals (Sweden)

    M. Subirana Domènech

    2011-06-01

    Full Text Available La agenesia de vena cava inferior es una entidad congénita poco frecuente que a menudo se asocia con otras severas anomalías congénitas o malposiciones viscerales. También ha sido descrita como un factor de riesgo de trombosis venosa en pacientes jóvenes. La mayoría de los casos publicados proceden de estudios radiológicos y muy raramente aparece como hallazgo necrópsico. Presentamos un caso de agenesia de vena cava inferior, sin otras anomalías asociadas, que apareció como hallazgo incidental en una autopsia forense.The absence of the inferior vena cava is a rare congenital anomaly, often associated with severe congenital deformities and visceral position abnormalities. It has been described also as a risk factor for deep vein thrombosis in young patients. We present a case of congenital absence of inferior vena cava appeared as an incidental finding in a forensic autopsy.

  15. An autopsy report on multiple system atrophy diagnosed immunohistochemically despite severe ischaemic damage: a new approach for investigation of medical practice associated deaths in Japan.

    Science.gov (United States)

    Nakajima, M; Kojima, H; Takazawa, Y; Yahagi, N; Harada, K; Takahashi, K; Unuma, K; Yoshida, K

    2009-11-01

    A 60-year old man with a 10-year history of multiple system atrophy (MSA) was found in respiratory arrest. After 4 months of respiratory support with two episodes of septic shock, he died. Autopsy disclosed severe atrophy of the mesencephalon, brainstem, medulla oblongata and cerebellum. Gallyas-Braak, alpha-synuclein and ubiquitin-positive inclusions in the cytoplasm of glial cells were evident, despite the severe ischaemic damage due to respiratory arrest and subsequent respiratory support for 4 months. The cause of respiratory arrest was not identified, but could be explained by the natural history of MSA. The bereaved family, who had suspected malpractice, was satisfied with the explanation based on the investigation performed by eight expert doctors, one expert nurse, two coordinator nurses and two lawyers in the model project promoted by the Japanese government. PMID:19861562

  16. Child and elderly victims in forensic autopsy during a recent 5 year period in the southern half of Osaka city and surrounding areas.

    Science.gov (United States)

    Zhu, B L; Oritani, S; Ishida, K; Quan, L; Sakoda, S; Fujita, M Q; Maeda, H

    2000-09-11

    To outline the recent features of child and elderly victims from the medico-legal perspective with special reference to abuse and neglect, a retrospective investigation of forensic autopsy cases over a 5 year period (1994-1998) in the southern half of Osaka city and surrounding areas (a population of 1.57 million) was undertaken. Among 646 autopsy cases, there were 53 child cases (under the age of 15 years, about 80% below 6) and 121 elderly cases (65 years old and above). Nearly half of the child deaths and more than half of the elderly deaths were described as accidental. Fire and traffic victims were much more frequent in the elderly. Child victims included those of neonaticide/infanticide (n=6), physical abuse (n=10), unintentional fatal infliction (n=2), neglect (n=2), mutual suicide (n=2), suicide (n=1) and murder (n=3). Child abuse and neglect were domestic maltreatment by the parents. In this series, there was a comparable number of fatalities due to maltreatment in the elderly (n=13) and in children, and non-domestic violence was more frequent in the elderly than domestic violence. Elderly females tended to be battered by their sons or grandsons in domestic violence cases, whereas males were predominantly attacked by younger males in non-domestic violence. The other elderly victims included those of self-neglect (n=2), murder (n=7) and suicide (n=9). Non-domestic homicide of the elderly occurred mainly in the center of the city, whereas domestic maltreatment of children and the elderly was sporadic, although somewhat more frequent in the peripheral zone of the city and the surrounding areas. The above profile of child and elderly abuse suggests a substantial influence of social and familial backgrounds. PMID:10978628

  17. Proof of live birth using postmortem multislice computed tomography (pmMSCT) in cases of suspected neonaticide: advantages of diagnostic imaging compared to conventional autopsy.

    Science.gov (United States)

    Guddat, Saskia S; Gapert, René; Tsokos, Michael; Oesterhelweg, Lars

    2013-03-01

    Proof of live birth is of major importance in suspected neonaticide cases. Although not without controversy the lung flotation test is the main method used to asses this in different jurisdictions worldwide. The present study examines the usefulness of postmortem multislice computed tomography (pmMSCT) in the detection of live birth signs. Body scans were conducted on four infants, one was stillborn, another died a day after birth and the other two were classified as neonaticides. The appearance of the lungs, gastrointestinal tract and vascular system of the liver was compared in these cases. Clear differences were discernable between the lungs of the stillborn and the 1 day old infant. The aerated lungs and air in the stomach and duodenum were clearly visible in the latter case while the stillborn infant lacked these signs. The two neonaticide cases demonstrated similarly aerated lung tissue to the 1 day old infant. The hepatic vessels did not show any putrefactive gas changes in any of the cases. The extent of aeration of the peripheral alveoli was easily observable on the pmMSCT, thus making it a useful tool in the possible differentiation between artificially and naturally aerated lungs. During the four autopsies the classic flotation tests were performed and similar positive aeration of the lungs in the two neonaticides was shown. The stillborn's tests, on the other hand were negative for aeration. The results of this study clearly demonstrate the advantages of using pmMSCT before commencing a conventional autopsy in cases of suspected neonaticide. PMID:22760696

  18. Post-mortem Whole exome sequencing with gene-specific analysis for autopsy-negative sudden unexplained death in the young: a case series.

    Science.gov (United States)

    Narula, Nupoor; Tester, David J; Paulmichl, Anna; Maleszewski, Joseph J; Ackerman, Michael J

    2015-04-01

    Annually, thousands of sudden deaths in individuals under 35 years remain unexplained following comprehensive medico-legal autopsy. Previously, post-mortem genetic analysis by Sanger sequencing of four major cardiac channelopathy genes revealed that approximately one-fourth of these autopsy-negative sudden unexplained death in the young (SUDY) cases harbored an underlying mutation. However, there are now over 100 sudden death-predisposing cardiac channelopathy-, cardiomyopathy-, and metabolic disorder-susceptibility genes. Here, we set out to determine whether post-mortem whole exome sequencing (WES) is an efficient strategy to detect ultra-rare, potentially pathogenic variants. We performed post-mortem WES and gene-specific analysis of 117 sudden death-susceptibility genes for 14 consecutively referred Caucasian SUDY victims (average age at death 17.4 ± 8.6 years) to identify putative SUDY-associated mutations. On average, each SUDY case had 12,758 ± 2,016 non-synonymous variants, of which 79 ± 15 localized to these 117 genes. Overall, eight ultra-rare variants (seven missense, one in-frame insertion) absent in three publically available exome databases were identified in six genes (three in TTN, and one each in CACNA1C, JPH2, MYH7, VCL, RYR2) in seven of 14 cases (50 %). Of the seven missense alterations, two (T171M-CACNA1C, I22160T-TTN) were predicted damaging by three independent in silico tools. Although WES and gene-specific surveillance is an efficient means to detect rare genetic variants that might underlie the pathogenic cause of death, accurate interpretation of each variant is challenging. Great restraint and caution must be exercised otherwise families may be informed prematurely and incorrectly that the root cause has been found. PMID:25500949

  19. Birth attendants as perinatal verbal autopsy respondents in low-and middle-income countries: a viable alternative? / Les sages-femmes pour répondre aux questions de l'autopsie verbale périnatale dans les pays à revenu faible et moyen: une alternative viable? / Las matronas como encuestadas en autopsias verbales perinatales en países de ingresos bajos y medios: ¿una alternativa viable?

    Scientific Electronic Library Online (English)

    C, Engmann; A, Garces; I, Jehan; J, Ditekemena; M, Phiri; V, Thorsten; M, Mazariegos; E, Chomba; O, Pasha; A, Tshefu; D, Wallace; EM, McClure; RL, Goldenberg; WA, Carlo; LL, Wright; C, Bose.

    2012-03-01

    Full Text Available OBJETIVO: Evaluar la viabilidad de utilizar matronas como encuestadas en autopsias verbales perinatales en lugar de madres que han perdido un hijo/a. MÉTODOS: Las entrevistas para las autopsias verbales de muertes neonatales prematuras y alumbramientos mortinatos se realizaron por separado entre mad [...] res (estándar de referencia) y matronas en 38 comunidades de cuatro países en desarrollo. Se calculó la concordancia entre las respuestas maternas y las respuestas de las matronas para todas las preguntas, tanto para las categorías de preguntas como para las preguntas individuales. Se evaluaron la sensibilidad y especificidad de las preguntas individuales con la matrona como encuestada. RESULTADOS: En las muertes neonatales prematuras, la concordancia en todas las preguntas fue del 94%. La concordancia fue de al menos el 95% para más de la mitad de las preguntas sobre el historial médico materno, atención en el parto y características neonatales. La concordancia de cualquier pregunta determinada no fue en ningún caso inferior al 80%. La sensibilidad y la especificidad variaron en las preguntas individuales. En este caso, más del 80% de las preguntas presentaron una sensibilidad de al menos el 80% y una especificidad de al menos el 90%. En cuanto a los alumbramientos mortinatos, la concordancia en todas las preguntas fue del 93%. La concordancia fue del 95% o más durante más de la mitad del tiempo para preguntas relacionadas con la atención en el parto, el centro de parto y las características de la mortinatalidad. La sensibilidad y especificidad variaron en las preguntas individuales. Más del 60% de las preguntas presentaron una sensibilidad de al menos el 80%. En este caso, más del 80% de las preguntas presentaron una especificidad de al menos el 90%. Globalmente, las causas de muerte establecidas mediante autopsia verbal fueron similares, independientemente de la persona encuestada. CONCLUSIÓN: Las matronas pueden sustituir a las madres que han perdido un hijo/a como encuestadas en autopsias verbales. Es necesario perfeccionar las preguntas de los cuestionarios de autopsia verbal armonizados existentes, ya que su sensibilidad y especificidad difieren ampliamente. Abstract in english OBJECTIVE: To assess the feasibility of using birth attendants instead of bereaved mothers as perinatal verbal autopsy respondents. METHODS: Verbal autopsy interviews for early neonatal deaths and stillbirths were conducted separately among mothers (reference standard) and birth attendants in 38 com [...] munities in four developing countries. Concordance between maternal and attendant responses was calculated for all questions, for categories of questions and for individual questions. The sensitivity and specificity of individual questions with the birth attendant as respondent were assessed. FINDINGS: For early neonatal deaths, concordance across all questions was 94%. Concordance was at least 95% for more than half the questions on maternal medical history, birth attendance and neonate characteristics. Concordance on any given question was never less than 80%. Sensitivity and specificity varied across individual questions, more than 80% of which had a sensitivity of at least 80% and a specificity of at least 90%. For stillbirths, concordance across all questions was 93%. Concordance was 95% or greater more than half the time for questions on birth attendance, site of delivery and stillborn characteristics. Sensitivity and specificity varied across individual questions. Over 60% of the questions had a sensitivity of at least 80% and over 80% of them had a specificity of at least 90%. Overall, the causes of death established through verbal autopsy were similar, regardless of respondent. CONCLUSION: Birth attendants can substitute for bereaved mothers as verbal autopsy respondents. The questions in existing harmonized verbal autopsy questionnaires need further refinement, as their sensitivity and specificity differ widely.

  20. Discrepancia entre los diagnósticos clínicos y por autopsia en un hospital pediátrico de tercer nivel / Discrepancy between clinical diagnoses versus autopsy findings in a third-level pediatric hospital

    Scientific Electronic Library Online (English)

    Vesta, Richardson-López Collada; Diana Leticia, Coronel-Martínez.

    2006-08-01

    Full Text Available Introducción. La utilidad de la autopsia ha sido reconocida ampliamente para fines de educación médica y en la evaluación de la calidad diagnóstica y terapéutica. Desde 1972 hasta 2002, no se ha demostrado un descenso en el número de discrepancias entre los diagnósticos clínicos y de autopsia. El pr [...] esente estudio permite determinar la concordancia entre los diagnósticos clínicos y de autopsia en una institución pediátrica de tercer nivel, como una herramienta para mejorar la calidad de atención médica. Los objetivos fueron: 1. Obtener el porcentaje de discordancia entre los diagnósticos clínicos y por autopsia en el Hospital Infantil de México Federico Gómez en el período de un año. 2. Determinar, de acuerdo a la clasificación de Goldman modificada por Battle, cuáles son las discrepancias más frecuentes. 3. Calcular la posible asociación entre número de ingresos, tiempo de hospitalización, edad del médico tratante y edad del paciente con el grado de discordancia entre los diagnósticos. Material y métodos. Se efectuó un estudio retrospectivo, observacional, comparativo y transversal. Se analizaron todos los casos de autopsia atendidos entre el 1 de enero y el 31 de diciembre de 2004. Las variables estudiadas fueron: edad, género, número de ingresos y su duración, principal servicio tratante, tipo de autopsia, diagnóstico clínico principal, probable causa de muerte clínica y por autopsia. Resultados. En 2004 se registraron 209 defunciones, con 62 autopsias (29.7%). Hubo discrepancia en 15 casos (24.6%), y de acuerdo a los criterios de Goldman modificados por Battle, se encontró error clase I en 5 casos (8.2%) y clase II en 4 casos (6.6%). No hubo diferencias estadísticamente significativas entre los tipos de error cuando se compararon los pacientes por grupo de edad, duración de la hospitalización, número de ingresos y edad del médico tratante. Conclusión. El mayor número de discrepancias entre diagnósticos clínicos y por autopsia se observó en casos con enfermedades infecciosas. Esta discordancia es similar a la reportada en otros sitios del mundo. Abstract in english Introduction. The autopsy has been recognized as a useful tool for medical education and for quality improvement, evaluating therapeutic and diagnostic measures. In the last 50 years, the autopsy rates have constantly declined. Interestingly, between 1972 and 2002, the discrepancies between clinical [...] diagnoses and autopsy findings haven't diminished, even with all the technological improvements now available. This research enables us to determine the discrepancy rate between our clinical diagnosis and autopsy results, as well as the main diseases that need diagnostic or therapeutic improvements in our hospital. Our objectives were: 1. To obtain the discrepancy rate between clinical diagnoses and autopsy findings. 2. To determine the most frequent type of discrepancy, according with the Goldman criteria, modified by Battle, and 3. To evaluate the possible association of these discrepancies with the number of admissions, length of stay, patient's age and physician's age. Material and methods. A retrospective, observational, comparative and transversal study. Sample: all cases that had an autopsy between January 1st and December 31th 2004. Cases with an incomplete record were excluded. The main variables analyzed were: age, gender, number of admissions and their length of stay, main clinical service, type of autopsy, main clinical and autopsy diagnoses and probable cause of death. Results. In the year 2004 there were 209 deaths registered with 62 autopsies (29.7% rate). We found a discrepancy in the main clinical diagnosis in 15 cases (24.6%); and, according with the Goldman criteria, modified by Battle, we found a class I discrepancy in 5 cases (8.2%) and a class II discrepancy in 4 cases (6.6%). We didn't find significant statistical differences in patients older than a year compared with patients less than 1 year old. There were no significant differences regarding the number of

  1. La autopsia en los 50 años del Hospital Militar Central "Dr. Luis Díaz Soto" / Autopsies in the 50 years of "Dr. Luis Díaz Soto" Central Military Hospital"

    Scientific Electronic Library Online (English)

    Teresita, Montero González; José, Hurtado de Mendoza Amat.

    2013-12-01

    Full Text Available Introducción: en 1985 se presentó el Sistema Automatizado de Registro y Control de Anatomía Patológica, objeto de estudio para la docencia y múltiples investigaciones. Objetivo: actualizar las principales causas de muerte en adultos y obtener las experiencias para elevar la calidad de la asistencia [...] médica que se brinda. Métodos: estudio retrospectivo, longitudinal con el referido sistema entre los años 1962 y 2011 de las autopsias realizadas en el Hospital Militar Central "Dr. Luis Díaz Soto". Se analizaron los grupos de edad, sexo, especialidad de egreso, presencia de infección, cáncer, daño múltiple de órganos, causas de muerte y relación clínico-patológica. Resultados: la mitad de los casos fallecidos ocurrió en el área de atención al grave y el daño múltiple de órganos afectó casi el 50 %. La bronconeumonía y el infarto cardiaco constituyeron las principales causas de muerte, mientras que en las básicas resultaron las aterosclerosis. Las discrepancias para ambas causas de muerte fueron de una cada cinco autopsias. Conclusiones: las principales causas de muerte permiten caracterizar los principales problemas de salud. El Sistema Automatizado de Registro y Control de Anatomía Patológica y el daño múltiple de órganos han sido logros importantes de la especialidad obtenidos en 50 años en el Hospital Militar Central "Dr. Luis Díaz Soto". La metodología de trabajo alcanzada en el estudio de la autopsia en dicha institución constituye referencia para otros hospitales y permite elevar la calidad de la asistencia médica que se brinda. Abstract in english Introduction: the Automated Pathological Anatomy Registration and Control System was first introduced in the year 1985 as an object of study for both teaching and a large number of research tasks. Objective: update the main causes of death among adults and obtain experience useful to improve the qua [...] lity of the medical care offered. Methods: retrospective longitudinal study, based on the aforementioned system, of the autopsies performed at "Dr. Luis Díaz Soto" Central Military Hospital between the years 1962 and 2011. The variables analyzed were age group, sex, discharge specialty, presence of infection, cancer, multiple organ damage, cause of death and clinico-pathological relationship. Results: half of the deaths occurred in the critical care area, and multiple organ damage affected nearly 50 %. Bronchopneumonia and cardiac infarction were the main causes of death, whereas atherosclerosis were the basic causes of death. Discrepancies for both causes of death were one in every five autopsies. Conclusions: the main causes of death make it possible to characterize the main health problems. The Automated Registration and Control System for Pathological Anatomy and multiple organ damage is an important achievement obtained by the specialty in the 50 years of "Dr. Luis Díaz Soto" Central Military Hospital. The methodology developed for the study of autopsies in the center constitutes a reference for other hospitals, and makes it possible to improve the quality of the medical care offered.

  2. Autopsy-proven causes of death in lungs of patients immunocompromised by secondary interstitial pneumonia / Causas de óbito por pneumonia intersticial secundária em autópsias pulmonares de pacientes imunocomprometidos

    Scientific Electronic Library Online (English)

    Alberto Antonio, Terrabuio Junior; Edwin Roger, Parra; Cecília, Farhat; Vera Luiza, Capelozzi.

    2007-02-01

    Full Text Available OBJETIVO: Apresentar as associações mais freqüentes encontradas em autópsias de pacientes imunossuprimidos que desenvolveram pneumonia intersticial secundária bem como o risco de óbito (Odds Ratio) de desenvolver PIS associada à causa da imunossupressão. MÉTODO: De janeiro de 1994 a março de 2004, 1 [...] 7000 autópsias foram realizadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A partir da revisão dos laudos patológicos foram selecionados 558 destas autópsias (3,28%) de pacientes com 15 anos de idade ou mais, com alguma doença de base que desenvolveu um infiltrado pulmonar radiologicamente difuso durante o curso da hospitalização e que depois foi para óbito com pneumonia intersticial secundária (broncopneumonia, pneumonia lobar, pneumonia intersticial, dano alveolar difuso, doença pulmonar recorrente, doença pulmonar induzida por drogas, edema pulmonar cardiogênico e embolismo pulmonar). As lâminas histológicas foram revisadas por patologistas experientes para confirmar ou não a presença de pneumonia intersticial secundária. A análise estatística incluiu o "Teste exato de Fisher" para verificar associação entre a histolopatologia e causa de imunocomprometimento; e regressão logística para predizer o risco de óbito por achados histológicos específicos para cada variável independente do modelo. RESULTADOS: A pneumonia intersticial secundária foi representada histológicamente por pneumonite intersticial difusa variando de características não especificas leves (n=213) ao padrão histológico de dano alveolar difuso (n=273). A principal causa de imunossupressão nos pacientes com dano alveolar difuso foi sepse (136 casos), neoplasia (113 casos), diabetes melito (37 casos) e transplantados (37 casos). O maior risco de morte por edema pulmonar foi encontrado nos pacientes com carcinoma de cólon. Da mesma forma, nos pacientes com câncer pulmonar ou cachexia ocorreu um alto risco de morte (OR=3.6; OR=2.6, respectivamente) por broncopneumonia. O tromboembolismo pulmonar ofereceu um importante risco de morte (OR=2.4) nos pacientes com hipertensão arterial. Observou-se também risco de morte por câncer hepático (OR=2.5) ou terapia esteroidea (OR=2.4) nos pacientes que desenvolveram hemorragia pulmonar com padrão histológico de pneumonia intersticial secundária. Da mesma forma houve alto risco de morte por metástase pulmonar (OR= 1.6) nos pacientes imunossuprimidos após radioterapia. CONCLUSÃO: Pacientes com imunossupressão secundária que desenvolveram pneumonia intersticial secundária durante o tratamento dentro do hospital podem ser avaliados para evitar como evento final o dano alveolar difuso, o edema pulmonar, a broncopneumonia, a hemorragia pulmonar, o tromboembolismo pulmonar e a metástase pulmonar. Os pacientes com aumento de risco são aqueles imunossuprimidos por doença hematológica, sob tratamento com esteroides, carcimona hepático, cachexia e hipertensão. Abstract in english PURPOSE: To present the more frequent associations found in autopsies of immunocompromised patients who developed secondary interstitial pneumonia as well as the risk of death (odds ratio) in having specific secondary interstitial pneumonia according to the cause of immunocompromise. METHOD: From Ja [...] nuary 1994 to March 2004, 17,000 autopsies were performed at Hospital das Clínicas, São Paulo University Medical School. After examining the pathology report review, we selected 558 of these autopsies (3.28%) from patients aged 15 years or more with primary underlying diseases who developed radiologically diffuse infiltrates of the lung during their hospital course and died after secondary interstitial pneumonia (bronchopneumonia, lobar pneumonia, interstitial pneumonia, diffuse alveolar damage, pulmonary recurrence of underlying disease, drug-induced lung disease, cardiogenic pulmonary edema, or pulmonary embolism). Histology slides were reviewed by experienced pathologists to confirm or not the presence of secondary interstitial

  3. Autopsy-proven causes of death in lungs of patients immunocompromised by secondary interstitial pneumonia Causas de óbito por pneumonia intersticial secundária em autópsias pulmonares de pacientes imunocomprometidos

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    Alberto Antonio Terrabuio Junior

    2007-02-01

    Full Text Available PURPOSE: To present the more frequent associations found in autopsies of immunocompromised patients who developed secondary interstitial pneumonia as well as the risk of death (odds ratio in having specific secondary interstitial pneumonia according to the cause of immunocompromise. METHOD: From January 1994 to March 2004, 17,000 autopsies were performed at Hospital das Clínicas, São Paulo University Medical School. After examining the pathology report review, we selected 558 of these autopsies (3.28% from patients aged 15 years or more with primary underlying diseases who developed radiologically diffuse infiltrates of the lung during their hospital course and died after secondary interstitial pneumonia (bronchopneumonia, lobar pneumonia, interstitial pneumonia, diffuse alveolar damage, pulmonary recurrence of underlying disease, drug-induced lung disease, cardiogenic pulmonary edema, or pulmonary embolism. Histology slides were reviewed by experienced pathologists to confirm or not the presence of secondary interstitial pneumonia. Statistical analysis included the Fisher exact test to verify any association between histopathology and the cause of immunocompromise; a logistic regression was used to predict the risk of death for specific histological findings for each of the independent variables in the model. RESULTS: Secondary interstitial pneumonia was histologically represented by diffuse interstitial pneumonitis ranging from mild nonspecific findings (n = 213 to a pattern of diffuse alveolar damage (n = 273. The principal causes of immunocompromise in patients with diffuse alveolar damage were sepsis (136 cases, neoplasia (113 cases, diabetes mellitus (37 cases, and transplantation (48 cases. A high risk of death by pulmonary edema was found for patients with carcinoma of colon. Similarly, in patients with lung cancer or cachexia, A high risk of death by bronchopneumonia (OR = 3.6; OR = 2.6, respectively was found. Pulmonary thromboembolism was associated with an appreciable risk of death (OR = 2.4 in patients with arterial hypertension. The risk of death was also high in patients presenting hepatic cancer (OR = 2.5 or steroid therapy (OR = 2.4 who developed pulmonary hemorrhage as the histological pattern of secondary interstitial pneumonia . The risk of death by lung metastasis was also elevated (OR = 1.6 for patients that were immunosuppressed after radiotherapy. CONCLUSION: Patients with secondary immunosuppression who developed secondary interstitial pneumonia during treatment in hospital should be evaluated to avoid death by diffuse alveolar damage, pulmonary edema, bronchopneumonia, lung hemorrhage, pulmonary thromboembolism, or lung metastasis. The high-risk patients are those immunosuppressed by hematologic disease; those under steroid treatment; or those with colon or hepatic carcinoma, cachexia, or arterial hypertension.OBJETIVO: Apresentar as associações mais freqüentes encontradas em autópsias de pacientes imunossuprimidos que desenvolveram pneumonia intersticial secundária bem como o risco de óbito (Odds Ratio de desenvolver PIS associada à causa da imunossupressão. MÉTODO: De janeiro de 1994 a março de 2004, 17000 autópsias foram realizadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A partir da revisão dos laudos patológicos foram selecionados 558 destas autópsias (3,28% de pacientes com 15 anos de idade ou mais, com alguma doença de base que desenvolveu um infiltrado pulmonar radiologicamente difuso durante o curso da hospitalização e que depois foi para óbito com pneumonia intersticial secundária (broncopneumonia, pneumonia lobar, pneumonia intersticial, dano alveolar difuso, doença pulmonar recorrente, doença pulmonar induzida por drogas, edema pulmonar cardiogênico e embolismo pulmonar. As lâminas histológicas foram revisadas por patologistas experientes para confirmar ou não a presença de pneumonia intersticial secundária. A análise estatística incluiu o "Teste exato de Fisher" para verificar associação en

  4. Importancia y diagnóstico del daño múltiple de órganos en autopsias clínicas Importance and diagnosis of multiple organ failure in clinical autopsies

    Directory of Open Access Journals (Sweden)

    Teresita Montero González

    2008-06-01

    Full Text Available El estudio de más de 14 000 autopsias ha permitido integrar un conjunto de alteraciones morfológicas con el término de daño múltiple de órganos. El propósito del presente trabajo fue determinar la vigencia de los elementos diagnósticos iniciales del daño múltiple de órganos en fallecidos con factores causales. Se realizó un estudio de estos y se analizaron las relaciones de las causas de muerte con los factores causales y el número de órganos afectados con la estadía hospitalaria. Se revisaron 448 fallecidos y a quienes se les había realizado autopsia en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto". Se revisaron los protocolos de autopsias, historias clínicas y láminas histopatológicas. Se seleccionaron los 145 casos con criterio de daño múltiple de órganos que constituyeron el objeto de estudio del presente trabajo. Los resultados muestran la presencia del daño múltiple de órganos en un tercio de los fallecidos, que fue mayormente en los menores de 50 años y en los procedentes de las terapias y unidades de cuidados intermedios. Se destacan entre las causas de muerte el daño tisular severo y la infección. Los órganos más afectados fueron los pulmones, el intestino, las glándulas suprarrenales, el hígado y el cerebro. Estuvo presente el daño múltiple de órganos en el 59,3 % de los fallecidos entre los primeros 4 días de estadía hospitalaria, con predominio del daño en 5 y 6 órganos. El daño múltiple de órganos se presentó en más de un tercio de los casos estudiados. La respuesta del organismo ante los factores causales, desencadena la respuesta inflamatoria sistémica que se expresa morfológicamente en el daño múltiple de órganos y puede llevar al paciente a la muerte.The study of more than 14 000 autopsies has allowed to integrate a series of morphological alterations with the term of multiple organ damage. The purpose of this paper was to determine the validity of the initial diagnostic elements in the deceased with causal factors. A study of them was carried out and the relations of the death causes with the causal factors and of the number of organs affected with the hospital stay were analyzed. 448 dead, whose autopsy had been performed at "Dr. Luis Díaz Soto" Higher Institute of Military Medicine, were examined. The protocols of the autopsy, medical histories and histopathological laminae were reviewed. The 145 cases with criterion of multiple organ damage that were the object of study of this paper, were selected. The results showed the presence of multiple organ damage in a third of the dead. It was mostly observed in those under 50 and in the ones coming from the intermediate therapy and care units. Among the death causes, the severe tissue damage and infection stood out. The most affected organs were the lungs, the bowels, the suprarenal glands, the liver and the brain. Multiple organ damage was present in 59.3 % of the deceased in the first 4 days of hospital stay, with predominance of damage in 5 and 6 organs. The response of the organism to the causal factors triggers the systemic inflammatory response that is morphologically expressed in the multiple organ damage and may cause the death of the patient.

  5. Autopsia por silico-asbestosis: revisión a propósito de un caso forense / Autopsy by silico-asbestosis: a review of a forensic case

    Scientific Electronic Library Online (English)

    A., Sibón Olano; E., Sánchez Rodríguez; E., Barrera Pérez; J., Larrondo Espinosa; M., Salguero Villadiego.

    2014-09-01

    Full Text Available Se presenta el caso de un varón de 72 años de edad, ex fumador desde hace años, diagnosticado de silicosis y carcinoma epidermoide de pulmón derecho, solicitándose por parte de la familia autopsia judicial por la sospecha de padecimiento de asbestosis y tras su confirmación reclamación como enfermed [...] ad profesional. La exposición de este suceso nos permite realizar una revisión de una enfermedad profesional que suele pasar como desconocida en las salas de autopsia, a pesar de su repercusión judicial. La asbestosis es un tipo de neumoconiosis reconocida como enfermedad profesional producida por la inhalación de fibras de asbesto. Su inhalación provoca fibrosis pulmonar. Presenta un tiempo de latencia clínica inversamente proporcional al nivel de exposición. Además de fibrosis pulmonar pueden producirse derrames pleurales, placas fibrosas pleurales, mesoteliomas, carcinomas pleurales y carcinoma de laringe. La silicosis es la neumoconiosis producida por inhalación de partículas de sílice, entendiendo por neumoconiosis la enfermedad ocasionada por el depósito de polvo en los pulmones con una reacción patológica frente a este, en especial de tipo fibroso. La silicosis es una enfermedad fibrótica-pulmonar de carácter irreversible y considerada enfermedad profesional incapacitante en muchos países, una de cuyas variantes más raras es la silico-asbestosis, la cual requiere exposición al sílice y al amianto. Abstract in english The case is presented the case of a 72-year-old ex-smoker for years, diagnosed with silicosis and squamous cell carcinoma of the right lung, being requested by the judicial autopsy family suspected of suffering from asbestosis and after confirmation complaint as an occupational disease. The exposure [...] of this event allows us to conduct a review of an occupational disease usually happens as unknown in autopsy rooms despite its legal repercussions. Asbestosis is a type of pneumoconiosis recognized as an occupational disease caused by inhaling asbestos fibers. Inhalation causes pulmonary fibrosis in the lung presenting a time inversely proportional to the exposure level clinical latency. Besides pulmonary fibrosis may occur pleural effusions, pleural fibrous plaques, mesothelioma, pleural carcinomas and laryngeal carcinoma. Silicosis is produced by inhalation pneumoconiosis silica particles, meaning the disease caused by pneumoconiosis dust deposit in the lungs with a pathological reaction to the same, especially fibrous. Silicosis is a fibrotic lung disease-and considered irreversible disabling occupational disease in many countries one of which is the more rare variants silico asbestosis, which requires exposure to silica and asbestos.

  6. Hematoma Disecante de la Parte Torácica de la Aorta: Estudio Anatomopatológico de Siete Casos de Autopsias / Dissecting Hematoma of the Thoracic Aorta: Pathology Study of Seven Autopsy Cases

    Scientific Electronic Library Online (English)

    Julio César, Guerini; Andrea, Storniolo Squintone; Alba, Borchert; Ismael Bernardo, Fonseca; Rodolfo Esteban, Avila; Luis Santos, Spitale.

    1331-13-01

    Full Text Available El hematoma disecante de aorta (HDA) se define como la disección de la pared aórtica por la sangre, con formación de una nueva luz. Es la patología letal de la aorta más frecuentemente diagnosticada y ocurre con una frecuencia tres veces mayor que la rotura del aneurisma de la aorta abdominal. Nuest [...] ro objetivo es presentar siete casos de HDA observados en autopsias, describir los hallazgos anatomopatológicos y comentar la literatura. Los casos estudiados corresponden al Servicio de Patología del Instituto de Medicina Forense de Córdoba, Argentina. Los tejidos fueron fijados en formol al 10%, incluidos en parafina y coloreados con hematoxilina-eosina, tricrómico de Masson y PAS (Peryodic Acid Schiff). De los siete casos presentados cuatro correspondieron a mujeres (57,1%) y tres a hombres (42,8%). Todos los casos estudiados tenían antecedentes de hipertensión arterial. La evolución posible de la disección aórtica incluye: rotura de la adventicia con hemorragia masiva y muerte, comunicación nuevamente con la luz aórtica, propagación al ostium coronario, isquemia de órganos y la formación de un aneurisma. Abstract in english Dissecting aortic hematoma (DAH) is defined as the dissection of the aortic wall by the blood, with formation of a new light. It is the deadliest disease of the aorta and occurs more frequently diagnosed at a rate three times greater than the ruptured aneurysm of the abdominal aorta. Our goal is to [...] present seven cases of DAH observed in autopsies, describe the autopsy findings and comment on the literature. All cases studied belong to the Department of Pathology, Institute of Forensic Medicine of Cordoba, Argentina. The tissues were fixed in 10% formalin, embedded in paraffin and stained with hematoxylin-eosin, Masson trichrome and PAS (Peryodic Acid Schiff). Of all the cases studied, four were women (57.1%) and three men (42.8%). All had a history of hypertension. Evolution of aortic dissection may include: failure of the adventitia with massive hemorrhage and death, again communication with the aortic lumen, spread the coronary ostium, organ ischemia and aneurysm formation.

  7. Hematoma Disecante de la Parte Torácica de la Aorta: Estudio Anatomopatológico de Siete Casos de Autopsias Dissecting Hematoma of the Thoracic Aorta: Pathology Study of Seven Autopsy Cases

    Directory of Open Access Journals (Sweden)

    Julio César Guerini

    2011-12-01

    Full Text Available El hematoma disecante de aorta (HDA se define como la disección de la pared aórtica por la sangre, con formación de una nueva luz. Es la patología letal de la aorta más frecuentemente diagnosticada y ocurre con una frecuencia tres veces mayor que la rotura del aneurisma de la aorta abdominal. Nuestro objetivo es presentar siete casos de HDA observados en autopsias, describir los hallazgos anatomopatológicos y comentar la literatura. Los casos estudiados corresponden al Servicio de Patología del Instituto de Medicina Forense de Córdoba, Argentina. Los tejidos fueron fijados en formol al 10%, incluidos en parafina y coloreados con hematoxilina-eosina, tricrómico de Masson y PAS (Peryodic Acid Schiff. De los siete casos presentados cuatro correspondieron a mujeres (57,1% y tres a hombres (42,8%. Todos los casos estudiados tenían antecedentes de hipertensión arterial. La evolución posible de la disección aórtica incluye: rotura de la adventicia con hemorragia masiva y muerte, comunicación nuevamente con la luz aórtica, propagación al ostium coronario, isquemia de órganos y la formación de un aneurisma.Dissecting aortic hematoma (DAH is defined as the dissection of the aortic wall by the blood, with formation of a new light. It is the deadliest disease of the aorta and occurs more frequently diagnosed at a rate three times greater than the ruptured aneurysm of the abdominal aorta. Our goal is to present seven cases of DAH observed in autopsies, describe the autopsy findings and comment on the literature. All cases studied belong to the Department of Pathology, Institute of Forensic Medicine of Cordoba, Argentina. The tissues were fixed in 10% formalin, embedded in paraffin and stained with hematoxylin-eosin, Masson trichrome and PAS (Peryodic Acid Schiff. Of all the cases studied, four were women (57.1% and three men (42.8%. All had a history of hypertension. Evolution of aortic dissection may include: failure of the adventitia with massive hemorrhage and death, again communication with the aortic lumen, spread the coronary ostium, organ ischemia and aneurysm formation.

  8. The etiology of maternal mortality in developing countries: what do verbal autopsies tell us? / Etiologie des décès maternels dans les pays en développement: quelle est la valeur des autopsies verbales ? / Etiología de la mortalidad materna en los países en desarrollo: ¿qué valor tienen las autopsias verbales?

    Scientific Electronic Library Online (English)

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

    Full Text Available OBJETIVO: Reevaluar el valor práctico de los datos de autopsias verbales que, a falta de información más rigurosa, se han utilizado para describir las causas de mortalidad materna e identificar las prioridades de los programas destinados a reducir la mortalidad femenina en los países en desarrollo. [...] MÉTODOS: Reanalizamos los datos de autopsias verbales de un estudio de 145 defunciones maternas que tuvieron lugar en Guerrero, Querétaro y San Luis Potosí (México) en 1995, teniendo en cuenta otras causas de defunción y el sistema de clasificación de la OMS. Los resultados se compararon además con la información suministrada sobre certificados de defunción deficientes. RESULTADOS: La reclasificación reveló grandes diferencias en la atribución de defunciones maternas a causas médicas específicas únicas. CONCLUSIÓN: El método de las autopsias verbales presenta limitaciones inherentes como medio de anamnesis de los eventos médicos. Como mucho permite corroborar una vez más el hecho ya conocido de que la mortalidad entre las mujeres pobres que apenas tienen acceso a atención médica es mayor que entre las mujeres ricas que disfrutan de un mayor acceso a esa atención. Abstract in english 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.

  9. Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model

    OpenAIRE

    Carolyne Ndila; Evasius Bauni; George Mochamah; Vysaul Nyirongo; Alex Makazi; Patrick Kosgei; Benjamin Tsofa; Gideon Nyutu; Anthony Etyang; Peter Byass; Williams, Thomas N.

    2014-01-01

    Background: The vast majority of deaths in the Kilifi study area are not recorded through official systems of vital registration. As a result, few data are available regarding causes of death in this population. Objective: To describe the causes of death (CODs) among residents of all ages within the Kilifi Health and Demographic Surveillance System (KHDSS) on the coast of Kenya. Design: Verbal autopsies (VAs) were conducted using the 2007 World Health Organization (WHO) standard VA questionna...

  10. Infective endocarditis (IE) first diagnosed at autopsy: analysis of 31 cases in Ribeirão Preto, Brazil Endocardite infecciosa (EI) com diagnóstico feito apenas à necrópsia: análise de 31 casos ocorridos entre 1992 e 1997, em Ribeirão Preto, Brasil

    OpenAIRE

    Luiz Tadeu M Figueiredo; RUIZ-JUNIOR Everaldo; SCHIRMBECK Tarciso

    2001-01-01

    Thirty one infective endocarditis (IE) fatal cases whose diagnosis was first obtained at autopsy were studied. The clinical data of these patients (Group 1) showed significant differences compared to other 141 IE cases (Group 2). The average age of 53 years in Group 1 patients was 18 years higher than that of Group 2. The Group 1 patients had a low frequency of IE predisposing heart disease. Both patient groups presented fever (about 87%), but a significant low frequency of cardiac murmur (25...

  11. The influence of DNA repair on neurological degeneration, cachexia, skin cancer and internal neoplasms: autopsy report of four xeroderma pigmentosum patients (XP-A, XP-C and XP-D)

    OpenAIRE

    Lai, Jin-ping; Liu, Yen-chun; Alimchandani, Meghna; Liu, Qingyan; Aung, Phyu Phyu; Matsuda, Kant; Lee, Chyi-chia R.; Tsokos, Maria; Hewitt, Stephen; Rushing, Elisabeth J.; Tamura, Deborah; Levens, David L.; Digiovanna, John J.; Fine, Howard A.; Patronas, Nicholas

    2013-01-01

    BACKGROUND: To investigate the association of DNA nucleotide excision repair (NER) defects with neurological degeneration, cachexia and cancer, we performed autopsies on 4 adult xeroderma pigmentosum (XP) patients with different clinical features and defects in NER complementation groups XP-A, XP-C or XP-D. RESULTS: The XP-A (XP12BE) and XP-D (XP18BE) patients exhibited progressive neurological deterioration with sensorineural hearing loss. The clinical spectrum encompassed severe cachexia in...

  12. Methodological trends in studies based on verbal autopsies before and after published guidelines / Tendances méthodologiques des études reposant sur des autopsies verbales avant et après la publication de directives / Tendencias metodológicas de los estudios basados en autopsias verbales antes y después de la publicación de directrices al respecto

    Scientific Electronic Library Online (English)

    Rohina, Joshi; Andre Pascal, Kengne; Bruce, Neal.

    2009-09-01

    Full Text Available OBJETIVO: Informar sobre el seguimiento de las directrices publicadas a comienzos de los años noventa con recomendaciones específicas para el diseño de los futuros estudios de vigilancia de la mortalidad basados en autopsias verbales. MÉTODOS: Llevamos a cabo una búsqueda sistemática de la bibliogra [...] fía para localizar todos los estudios basados en autopsias verbales publicados antes de enero de 2006 y extraer de ellos un conjunto estándar de datos. Para comparar los estudios diseñados antes y después de que se formularan las recomendaciones se emplearon siete indicadores metodológicos clave. RESULTADOS: Hallamos 102 estudios realizados en 39 países; 60 se habían diseñado antes de que se publicaran las directrices, y 42 después de su publicación. Se observaron diferencias considerables en los métodos utilizados por esos 102 estudios. Aunque se detectaron algunas tendencias alentadoras, no hay indicios de que se hayan aplicado sistemáticamente las recomendaciones en materia de diseño. Más concretamente, no aumentó claramente la proporción de estudios con un cuestionario combinado (63% antes de las recomendaciones frente a 74% después de las mismas; p = 0,3), un encuestador adiestrado (70% frente a 70%; p = 1,0), un encuestado idóneo (98% frente a 100%; p = 1,0), un periodo de rememoración óptimo (84% frente a 97%; p = 0,2), algoritmos predefinidos (28% frente a 38%; p = 0,4), una opción para asignar varias causas de defunción (30% frente a 38%; p = 0,3), o un estudio de validación de seguimiento (83% frente a 72%; p = 0,7). CONCLUSIÓN: Las recomendaciones formuladas por los expertos para optimizar el diseño de los estudios basados en autopsias verbales se han aplicado solo parcialmente hasta la fecha. Un mayor cumplimiento de ese tipo de recomendaciones gracias a una colaboración más idónea entre los equipos de investigación permitiría probablemente obtener mejores estadísticas de mortalidad a partir del creciente número de estudios basados en autopsias verbales. Abstract in english OBJECTIVE: To report on the uptake of guidelines published in the early 1990s with specific recommendations about the design of future studies based on verbal autopsy conducted for mortality surveillance. METHODS: We conducted a systematic literature search of all verbal autopsy studies published be [...] fore January 2006 and extracted from the studies a standard set of data. We then compared studies designed before and after the recommendations were issued in terms of seven key methodological indicators. FINDINGS: We found 102 studies conducted in 39 countries; 60 were designed before and 42 after the guidelines were issued. The methods used in these 102 studies varied considerably. While some encouraging trends were noted, there is no evidence that the design recommendations have been systematically implemented. Specifically, there was no clear increase in the proportion of studies with a combined questionnaire (63% before recommendations versus 74% after; P = 0.3), a trained interviewer (70% versus 70%; P = 1.0), a suitable respondent (98% versus 100%; P = 1.0), an optimal recall period (84% versus 97%; P = 0.2), predefined algorithms (28% versus 38%; P = 0.4), an option for assigning multiple causes of death (30% versus 38%; P = 0.3), or a follow-up validation study (83% versus 72%; P = 0.7). CONCLUSION: Expert recommendations for optimal design of verbal autopsy studies have been incompletely implemented to date. Better uptake of design recommendations through enhanced collaboration between research teams is likely to produce better mortality statistics from an increasing number of verbal autopsy studies.

  13. Influence of CYP2D6 and CYP2C19 genotypes on venlafaxine metabolic ratios and stereoselective metabolism in forensic autopsy cases.

    Science.gov (United States)

    Karlsson, L; Zackrisson, A-L; Josefsson, M; Carlsson, B; Green, H; Kugelberg, F C

    2015-04-01

    We investigated whether polymorphisms in the CYP2D6 and CYP2C19 genes influence the metabolic ratios and enantiomeric S/R ratios of venlafaxine (VEN) and its metabolites O-desmethylvenlafaxine (ODV), N-desmethylvenlafaxine (NDV) and N,O-didesmethylvenlafaxine (DDV) in blood from forensic autopsy cases. In all, 94 postmortem cases found positive for VEN during toxicological screening were included. The CYP2D6 genotype was shown to significantly influence the ODV/VEN (P=0.003), DDV/NDV (P=0.010) and DDV/ODV (P=0.034) ratios. The DDV/ODV (P=0.013) and DDV/VEN (P=0.021) ratios were significantly influenced by the CYP2C19 genotype. The S/R ratios of VEN were significantly influenced by both CYP2D6 and CYP2C19 genotypes. CYP2D6 poor metabolizers (PMs) had lower S/R VEN ratios and CYP2C19 PMs had high S/R ratios of VEN in comparison. Our results show that the CYP2D6 genotype influences the O-demethylation whereas CYP2C19 influences the N-demethylation of VEN and its metabolites. In addition, we show a stereoselective metabolism where CYP2D6 favours the R-enantiomer whereas CYP2C19 favours the S-enantiomer. PMID:25245581

  14. Overexpression of p53 but not Rb in the cytoplasm of neurons and small vessels in an autopsy of a patient with Cockayne syndrome.

    Science.gov (United States)

    Miyahara, Hiroaki; Itonaga, Tomoyo; Maeda, Tomoki; Izumi, Tatsuro; Ihara, Kenji

    2015-06-01

    Cockayne syndrome presents senescence-like changes starting in early infancy; however, the mechanism of premature aging remains unclear. In an autopsy of a 23-year-old woman with Cockayne syndrome, we evaluated the correlation between Cockayne pathology and the expression patterns of the senescence-associated proteins p53 and Rb. Neuropathological findings in this case revealed basal ganglia calcification, tigroid leukodystrophy, bizarre reactive astrocytes, severe cerebellar atrophy with loss of Purkinje cells, and arteriolar/neuronal calcifications in the hypothalamus. Multiple arteriolar calcifications and sclerotic changes were seen in the central nervous system and kidney, but the endothelium of the aorta and coronary arteries remained intact appropriately for the individual's age without any finding of arteriosclerosis. Overexpression of p53 protein was confirmed in the cytoplasm of neurons in the basal ganglia, thalamus, hypothalamus, hippocampus and cerebellum, of arteriolar endothelial cells of the cerebrum and renal glomerular capillaries, and of cutaneous epithelial cells. The distribution of p53 overexpression was coincident with that of pathological alteration, such as neuronal loss, calcification and atrophy. High expression of p53 was localized in the cytoplasm, not in the nucleus. In contrast to p53, Rb was not expressed in any senescence lesion. In terms of senescence, distinct differences are found among organs in a patient with Cockayne syndrome. This segmental progeria differs from natural aging, and implicates p53 overexpression in the etiology of CS. PMID:25495205

  15. A comparison of long-term retention of plutonium oxide in lung based on excretion data with observed lung burdens at autopsy

    International Nuclear Information System (INIS)

    Experience in the nuclear industry has shown that the most FR-equent route for significant plutonium deposition in man is by inhalation. After an accidental inhalation exposure to plutonium oxide has occurred, an attempt is usually made to determine the lung burden using in-vivo measurement techniques. However, this will not be possible if the amount deposited is less than the detection capability of the counter. Likewise, it may not be possible for even larger intakes if they are first discovered as a results of a routine examination after much of the plutonium has transferred out of the lungs. Under these conditions, the initial lung burden and dose assessment may, of necessity, be based entirely on excretion date. This paper discusses three plutonium inhalation cases for which autopsy data are available to demonstrate the difficulties and uncertainties of such assessments and to emphasize the need for enhanced routine surveillance of the worker and work place to assure that intakes are detected at the time they occur. An in-depth review of the findings for these three cases suggests that the use of urine excretion data applied to ICRP lung model assumption will result in large uncertainties in estimates of the pulmonary burden and lung dose. These estimates will be improved if the material inhaled can be better characterized and by using clearance half times developed for the individual rather than the default values for Class Y material recommended by the ICRP

  16. The effects of aging on biceps brachii muscle fibers: a morphometrical study from biopsies and autopsies / Efeitos do envelhecimento sobre as fibras do músculo biceps braquial: estudo morfométrico em biópsias e autópsias

    Scientific Electronic Library Online (English)

    Ana Cláudia, Mattiello-Sverzut; Leila, Chimelli; Maria Silvia de Assis, Moura; Silvia, Teixeira; José Alberto Mello de, Oliveira.

    2003-09-01

    Full Text Available OBJETIVOS: Para estudar a morfologia e o tamanho das fibras musculares, foram comparadas cortes transversos do bíceps braquial autopsiados, até 9 horas após o óbito, com biopsias musculares, em 72 indivíduos de ambos os sexos e idades entre 13 e 84 anos. MÉTODO: As amostras das autópsias (n=47) fora [...] m obtidas de indivíduos que morreram subitamente, ou após uma doença aguda sem evidência de comprometimento neuromuscular. As biópsias (n=25) foram obtidas de pacientes com sintomas sugestivos de miopatias inflamatória ou metabólica, não confirmadas morfologicamente. O diâmetro menor das fibras foi obtido usando a reação de ATPase. RESULTADOS: A análise morfológica mostrou que as mudanças induzidas pelo envelhecimento estiveram presentes a partir da sexta década para autópsias e consistiu de atrofia e grupamento de tipo. O modelo estatístico ajustado para mulheres, para autópsias e biópsias, foi linear e não indicou variação do tamanho das fibras com o aumento da idade. O modelo ajustado para homens, para ambos os casos, foi quadrático, indicando que a idade influenciou o tamanho dos diferentes tipos de fibras. Para homens, as fibras tipo 2 apresentaram-se maiores que as de tipo 1, e maiores que as das mulheres. CONCLUSÃO: Os valores encontrados podem ser úteis como controles, auxiliando na interpretação de modificações no tamanho das fibras para amostras provindas de biópsia e autópsia. Abstract in english OBJECTIVES: In order to study the morphology and size of muscle fibers, cross sections of biceps brachii samples from autopsies, up to 9 hours after death, and biopsies of 72 subjects were compared. The subjects aged 13 to 84 years in both sexes. METHODS: The samples obtained from autopsies (n=47) w [...] ere from subjects with sudden death, or who died after acute disease without evidence of neuromuscular involvement. The biopsies (n=25) were from patients with symptoms suggestive of inflammatory or metabolic myopathy, not confirmed morphologically. The lesser diameter of muscle fibers was measured using the ATPase reaction. RESULTS: Morphological analysis showed that aging changes were present from the sixth decade in autopsies, and consisted of atrophy and/or type-grouping. The statistical models adjusted for females in both autopsies and biopsies were linear straight with no variation in fiber size with increasing age. The models adjusted for males in both groups were quadratic, indicating that age influenced the size of different type fibers. In males type 2 were larger than type 1 fibers, and than fibers in females. CONCLUSIONS: These values might be useful as controls, helping interpretation of changes in fiber size in samples obtained from biopsies and autopsies.

  17. O decréscimo vertiginoso das autópsias em um hospital universitário do Brasil nos últimos 20 anos / The dramatic decline of the autopsies at a Brazilian university hospital in the last 20 years

    Scientific Electronic Library Online (English)

    Fabiana Resende, Rodrigues; Vânia Glória Silami, Lopes; Consuelo Lozoya, Lopez; Porphírio José, Soares Filho; Rita de Cássia Lauria Gonçalves da, Silva; Licínio Esmeraldo da, Silva; Graça Helena M. de Canto, Teixeira.

    2011-08-01

    Full Text Available INTRODUÇÃO: O declínio no número de autópsias em hospitais e instituições universitárias é evento amplamente reportado, inicialmente em países do primeiro mundo e posteriormente em muitos países em desenvolvimento, como o Brasil. As causas para essa tendência são múltiplas e complexas, incluindo asp [...] ectos religiosos, familiares e médicos. Entre estes últimos, salientam-se razões diagnósticas, caracterizadas pelo significativo avanço tecnológico na imagenologia, com a suposição de que todos os diagnósticos agora podem ser feitos em vida, e a crescente ansiedade de processos judiciais contra médicos por má prática. OBJETIVO: Demonstrar o decréscimo vertiginoso e drástico do número de autópsias em um hospital universitário no Brasil. MATERIAL E MÉTODO: Avaliou-se o número de registros nos livros de autópsias consecutivas realizadas no Departamento de Patologia do Hospital Universitário Antonio Pedro da Universidade Federal Fluminense (HUAP/UFF), Niterói, Rio de Janeiro, criando um banco dados em tabela do programa Microsoft Excel. RESULTADOS: Durante os anos 1966 a 2009, foram realizadas 23.813 necrópsias, sendo 12.702 de adultos e 11.111 de fetos. Entre os anos 1966 e 1998, foram realizadas mais necrópsias, no total de 23.321, sendo 12.482 de adultos e 10.839 de fetos. Já entre os anos 1999 e 2009, foi observado o declínio acentuado e drástico das mesmas, totalizando apenas 492 necrópsias, sendo 220 de adultos e 272 de fetos. CONCLUSÃO: Acreditamos que a principal causa para esse declínio é a pouca informação da população, que desconhece que o saber é fruto de estudo, pesquisa, prática e aprimoramento. Abstract in english INTRODUCTION: The decline in the number of autopsies at hospitals and university hospitals has been widely reported, initially in developed countries and afterwards in several developing countries including Brazil. The causes for this trend are multiple and complex, encompassing religious, family an [...] d medical aspects. Among the latter, we highlight diagnostic reasons, which are characterized by major technological advances in clinical imaging associated with the underlying assumption that all diagnoses can currently be made before death. Furthermore, there is a growing concern about malpractice lawsuits. OBJECTIVE: To demonstrate the sharp decrease in the number of autopsies at a university hospital in Brazil. MATERIAL AND METHODS: We evaluated the number of autopsies conducted at the Pathology Department of Antonio Pedro University Hospital (HUAP), Niterói, Rio de Janeiro, and a database spreadsheet was created at Microsoft Excel. RESULTS: From 1966 to 2009, 23,813 autopsies were performed, comprising 12,702 adults and 11,111 fetuses. The highest number of autopsies occurred from 1966 to 1998, when 23,321 autopsies were performed, comprising 12,482 adults and 10,839 fetuses. Whereas, there was a dramatic decline from 1999 to 2009, when 492 autopsies were performed, including 220 adults and 272 fetuses. CONCLUSION: We believe that the main cause of this reduction is the lack of information among laypeople and medical professionals, who have neglected the fact that knowledge is ultimately acquired through study, investigation and practice.

  18. Valor del diagnóstico de la tuberculosis pulmonar por autopsia en Cuba / Importance of the pulmonary tuberculosis diagnosis by autopsy in Cuba

    Scientific Electronic Library Online (English)

    Ana Ivonne, Martínez Portuondo; José, Hurtado de Mendoza Amat; Edilberto, González Ochoa.

    2012-03-01

    Full Text Available El diagnóstico de la tuberculosis pulmonar por autopsia mide la calidad de la atención médica y el comportamiento de la enfermedad. Objetivo: Determinar los fallecidos que murieron con y por Tuberculosis pulmonar y la concordancia entre los diagnósticos clínico y anatomopatológico en el período estu [...] diado. Método: Se examinaron 77 341 necropsias del Registro Nacional de Autopsias de Cuba, en adultos, del 1994 -2003. Se realizó un análisis multicausal de la muerte. Resultados: El 0.2 % de los pacientes murió con tuberculosis pulmonar y 0.04 % por tuberculosis pulmonar. El 71 % correspondió al sexo masculino y la edad promedio, 69 años de edad. La causa directa más frecuente de la muerte fue a expensas de la bronconeumonía. La discrepancia diagnóstica entre el diagnóstico clínico y el anatomopatológico señaló 26 % en la causa directa y 53 % en la causa básica de la muerte. Conclusiones: Los pacientes fallecieron en edades avanzadas y un porcentaje importante por Bronconeumonía. El estudio confirma que existe una frecuencia muy baja de tuberculosis pulmonar activa y concordancia diagnóstica en la mitad de los pacientes. También una discrepancia diagnóstica en la tercera parte de los casos como causa directa de la muerte. Quedaría definir por otras investigaciones los factores que influyen en los casos diagnosticados postmortem que mantienen la transmisión oculta de la enfermedad. Abstract in english The quality of medical care and the behaviour of the illness can be valued through the achievement of the pulmonary tuberculosis diagnosis by autopsy. Objective: To determine the patients who died with pulmonary tuberculosis and because of it and to establish the agreement between the clinical and t [...] he pathological diagnoses in the analized period. Method: A total of 77 341 necropsies taken from the Cuban national autopsies register were analized taking as reference a period of ten years (1994-2003).The clinical records were examined in those cases in which active tuberculosis was found. Results: The 0,2 % of the patients died with pulmonary tuberculosis and a 0.04 % died because of it. The average age was 69 years and 71 % of the persons were men. Broncho-pneumonia was the most important cause of death. The diagnostic discrepancy between clinical and pathological diagnosis showed a 26 % as the direct cause of death and a 53 % as the basic cause of death. Conclusion: An important percent of the deaths were by broncho-pneumonia and most of the patients died at an advanced age. It was confirmed a low frecuency of active pulmonary tuberculosis and there was diagnostic agreement in half of the patients. There was also a diagnostic disagreement in a third of the cases with direct cause of death. Other investigations could define the factors of the post-mortem cases diagnosed with pulmonary tuberculosis which keep hidden the transmission of this disease.

  19. Sudden Cardiac Death in Brazil: A Community-Based Autopsy Series (2006-2010) / Morte Súbita Cardíaca no Brasil: Análise dos Casos de Ribeirão Preto (2006-2010)

    Scientific Electronic Library Online (English)

    Maria Fernanda, Braggion-Santos; Gustavo Jardim, Volpe; Antonio, Pazin-Filho; Benedito Carlos, Maciel; José Antonio, Marin-Neto; André, Schmidt.

    2015-02-01

    Full Text Available Fundamento: Morte súbita cardíaca (MSC) é um evento súbito e inesperado, de causa cardiovascular, que ocorre em menos de uma hora após o início dos sintomas, em indivíduo sem qualquer condição clínica prévia potencialmente fatal ou assintomático nas últimas 24 horas antes do óbito, em caso de morte [...] não testemunhada. Apesar de ser um evento relativamente frequente, há poucos dados confiáveis na literatura sobre países em desenvolvimento. Objetivo: Descrever as características da MSC em Ribeirão Preto (SP 600.000 habitantes) baseando-se nos relatórios de autopsias do Serviço de Verificação de Óbitos do Interior. Métodos: Foram revisados retrospectivamente 4.501 relatórios de autopsias entre 2006 e 2010, para identificar casos de MSC. Foram coletados dados como causa específica do óbito, características demográficas e comorbidades das vítimas, data, local e hora do evento, e se foram realizadas manobras de ressuscitação cardiopulmonar (RCP). Resultados: Foram identificados 899 casos de MSC (20%; razão 30/100.000 habitantes por ano). A principal causa de MSC foi doença arterial coronariana (DAC - 64%), acometendo homens (67%) entre a sexta e a sétima década de vida. A maior parte dos eventos ocorreu durante a manhã, no domicílio (53,3%), e a RCP foi realizada em quase metade das vítimas (49,7%). A comorbidade mais prevalente foi hipertensão arterial sistêmica (57,3%). Doença de Chagas foi detectada em 49 casos (5,5%). Conclusão: A maioria dos casos de MSC ocorreu por DAC em homens entre a sexta e a sétima década de vida. Doença de Chagas, um importante problema de saúde pública na América Latina, foi detectada em 5,5% dos casos. Abstract in english Background: Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause, that occurs in less than one hour after the symptoms onset, in a person without any previous condition that would seem fatal or who was seen without any symptoms 24 hours before found dead. Although it is a r [...] elatively frequent event, there are only few reliable data in underdeveloped countries. Objective: We aimed to describe the features of SCD in Ribeirão Preto, Brazil (600,000 residents) according to Coroners’ Office autopsy reports. Methods: We retrospectively reviewed 4501 autopsy reports between 2006 and 2010, to identify cases of SCD. Specific cause of death as well as demographic information, date, location and time of the event, comorbidities and whether cardiopulmonary resuscitation (CPR) was attempted were collected. Results: We identified 899 cases of SCD (20%); the rate was 30/100000 residents per year. The vast majority of cases of SCD involved a coronary artery disease (CAD) (64%) and occurred in men (67%), between the 6th and the 7th decades of life. Most events occurred during the morning in the home setting (53.3%) and CPR was attempted in almost half of victims (49.7%). The most prevalent comorbidity was systemic hypertension (57.3%). Chagas’ disease was present in 49 cases (5.5%). Conclusion: The majority of victims of SCD were men, in their sixties and seventies and the main cause of death was CAD. Chagas’ disease, an important public health problem in Latin America, was found in about 5.5% of the cases.

  20. Tromboembolismo pulmonar en pacientes hospitalizados entre 1994-2000: serie de autopsia / Pulmonary thromboembolism in hospitalized patients during the period 1994-2000: an autopsy study

    Scientific Electronic Library Online (English)

    M. R., Burón Fernández; E., Pintor Holguín; P., Mínguez García; J. A., Nuevo González; J. J., Puche Paniagua; C., Gómez Sánchez-Biezma; P., Aragoncillo Ballesteros.

    2006-07-01

    Full Text Available Introducción: El tromboembolismo pulmonar (TEP) ha sido durante muchos años una causa muy importante de morbi-mortalidad en los pacientes hospitalizados. El empleo de forma profiláctica de Heparinas de Bajo Peso Molecular (HBPM) en pacientes ingresados en la última década del siglo XX parece haber d [...] isminuido de forma significativa su incidencia clínica. Pretendemos ver si el empleo de HBPM como medida de tromboprofilaxis ha modificado el hallazgo de esta patología en autopsias. Material y métodos: Estudio retrospectivo de todas las autopsias realizadas en adultos en el Hospital Clínico San Carlos (Madrid) en un periodo de 6 años (Enero 1994-Diciembre 1999). Se incluyeron en el estudio todas aquellas que presentaron hallazgos anatomopatológicos (AP) de TEP y se rellenó un protocolo en el que se incluyeron datos AP, datos epidemiológicos, clínicos y terapéuticos. Resultados: En el periodo estudiado se realizaron 483 necropsias, de las cuales 40 (8,3%) tenían datos de TEP. La mayor parte de ellos tenían más de 50 años (85%) y entre los factores de riesgo destacaron el reposo-encamamiento, la enfermedad crónica médica y la presencia de tumores malignos (adenocarcinomas). Sólo se sospechó el diagnóstico pre-mortem en 5 (12,5 %) y 15 (37,5 %) desarrollaron la ETE a pesar de haber recibido tratamiento profiláctico con HBPM. Conclusiones: El TEP continúa siendo una causa muy importante de mortalidad de los pacientes ingresados en el hospital. El aumento de la esperanza de vida, de la supervivencia de enfermedades crónicas médicas y tumorales determina que hay que tener muy en cuenta esta patología. El empleo de una HBPM como profilaxis no excluye la posibilidad de esta entidad. Abstract in english Background: Pulmonary thromboembolism (PTE) has been for a long time a significant cause of morbidity and mortality in hospitalized patients. The utility of Low-Molecular Weight Heparins (LMWH) in these patients in the last decade of the XX century has decreased the incidence of this disease. We try [...] to know if the massive useful of LMWH as thromboprophylasis is diminishing its incidence in autopsies. Material y methods: Retrospective study of all the autopsies in adults in the Hospital Clínico San Carlos (Madrid) in a period of 6 years (from January 1994 to December 1999). There were reviewed those necropsies which had pathological data of pulmonary thromboembolism and several items were studied: anatomopathological, epidemiological, clinical and therapeutical. Results: 483 necropsies were performed in this period; 40 (8.3%) had PE. Most of them were older than 50 years (85%) and the most important risk factors associated were bedridden, chronic cardiovascular diseases and malignant neoplasias. Only Pre-mortem diagnosis was only suspected in 5 patients (12.5%) and 15 of them (37.5%) had a fatal pulmonary embolism despite receipt of thromboprophylasis with LMWH. Conclusions: PTE is still an important cause of mortality in hospitalized patients. The increased of life expect, survival of chronic cardiovascular and malignant disease made PTE a frequent possibility situation in hospitalized patients. Receipt of LMWH as thromboprophylaxis is not always effective to avoid PTE.

  1. Sudden Cardiac Death in Brazil: A Community-Based Autopsy Series (2006-2010) / Morte Súbita Cardíaca no Brasil: Análise dos Casos de Ribeirão Preto (2006-2010)

    Scientific Electronic Library Online (English)

    Maria Fernanda, Braggion-Santos; Gustavo Jardim, Volpe; Antonio, Pazin-Filho; Benedito Carlos, Maciel; José Antonio, Marin-Neto; André, Schmidt.

    Full Text Available Fundamento: Morte súbita cardíaca (MSC) é um evento súbito e inesperado, de causa cardiovascular, que ocorre em menos de uma hora após o início dos sintomas, em indivíduo sem qualquer condição clínica prévia potencialmente fatal ou assintomático nas últimas 24 horas antes do óbito, em caso de morte [...] não testemunhada. Apesar de ser um evento relativamente frequente, há poucos dados confiáveis na literatura sobre países em desenvolvimento. Objetivo: Descrever as características da MSC em Ribeirão Preto (SP 600.000 habitantes) baseando-se nos relatórios de autopsias do Serviço de Verificação de Óbitos do Interior. Métodos: Foram revisados retrospectivamente 4.501 relatórios de autopsias entre 2006 e 2010, para identificar casos de MSC. Foram coletados dados como causa específica do óbito, características demográficas e comorbidades das vítimas, data, local e hora do evento, e se foram realizadas manobras de ressuscitação cardiopulmonar (RCP). Resultados: Foram identificados 899 casos de MSC (20%; razão 30/100.000 habitantes por ano). A principal causa de MSC foi doença arterial coronariana (DAC - 64%), acometendo homens (67%) entre a sexta e a sétima década de vida. A maior parte dos eventos ocorreu durante a manhã, no domicílio (53,3%), e a RCP foi realizada em quase metade das vítimas (49,7%). A comorbidade mais prevalente foi hipertensão arterial sistêmica (57,3%). Doença de Chagas foi detectada em 49 casos (5,5%). Conclusão: A maioria dos casos de MSC ocorreu por DAC em homens entre a sexta e a sétima década de vida. Doença de Chagas, um importante problema de saúde pública na América Latina, foi detectada em 5,5% dos casos. Abstract in english Background: Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause, that occurs in less than one hour after the symptoms onset, in a person without any previous condition that would seem fatal or who was seen without any symptoms 24 hours before found dead. Although it is a r [...] elatively frequent event, there are only few reliable data in underdeveloped countries. Objective: We aimed to describe the features of SCD in Ribeirão Preto, Brazil (600,000 residents) according to Coroners’ Office autopsy reports. Methods: We retrospectively reviewed 4501 autopsy reports between 2006 and 2010, to identify cases of SCD. Specific cause of death as well as demographic information, date, location and time of the event, comorbidities and whether cardiopulmonary resuscitation (CPR) was attempted were collected. Results: We identified 899 cases of SCD (20%); the rate was 30/100000 residents per year. The vast majority of cases of SCD involved a coronary artery disease (CAD) (64%) and occurred in men (67%), between the 6th and the 7th decades of life. Most events occurred during the morning in the home setting (53.3%) and CPR was attempted in almost half of victims (49.7%). The most prevalent comorbidity was systemic hypertension (57.3%). Chagas’ disease was present in 49 cases (5.5%). Conclusion: The majority of victims of SCD were men, in their sixties and seventies and the main cause of death was CAD. Chagas’ disease, an important public health problem in Latin America, was found in about 5.5% of the cases.

  2. Autopsias psicológicas de treinta suicidios en la IV Región de Chile / Psychological autopsies of thirty suicides of the IV Region of Chile

    Scientific Electronic Library Online (English)

    Alejandro, Gómez Ch; Raquel, Opazo P; Rosa, Levi A; María Soledad, Gómez Ch; Carolina, Ibáñez H; Carlos, Núñez M.

    2014-03-01

    Full Text Available Introducción: El suicidio es un problema de salud pública relevante en Chile. Este es el primer estudio chileno con el método de la autopsia psicológica (AP). Objetivos: a) identificar factores de riesgo de suicidio en víctimas chilenas; b) identificar indicadores de riesgo para la intervención temp [...] rana; c) evaluar la aceptabilidad del método de la AP por los informantes. Método: La muestra consistió en 30 sujetos (24 hombres y 6 mujeres) que cometieron suicidio en la IV Región de Chile (diciembre de 2008-septiembre de 2010). La información fue recogida de entrevistas a informantes. El instrumento principal fue el Protocolo de Entrevista para Autopsia Psicológica. Resultados: La edad promedio fue 35,8 años. La mayoría comunicó intención suicida antes de consumarlo. Casi todos experimentaron eventos negativos, frecuentemente poco antes del suicidio. La mitad había intentado suicidarse previamente, algunos durante el mes precedente. El 36% estaba en tratamientos de salud mental al fallecer y un cuarto había visitado recientemente a profesionales de salud mental. Se identificó trastornos psiquiátricos (CIE-10) en el 90%, principalmente trastorno depresivo y por uso de sustancias. Los trastornos de personalidad fueron evidentes en ocho víctimas (33%): disocial (4), emocionalmente inestable (2), paranoide (1) y ansioso (evitativo) (1). Conclusiones: Se confirmó una elevada tasa de trastornos psiquiátricos. El antecedente de intentos previos es un predictor sensible de suicidio. La comunicación de intención suicida es frecuente y puede ser una oportunidad de intervención. El suicidio es frecuentemente precedido por eventos vitales negativos. La prevención del suicidio puede mejorar mediante el tratamiento efectivo de trastornos psiquiátricos e intervenciones psicosociales focalizadas. El seguimiento intensivo de intentadores parece altamente relevante. La AP es aceptable para los informantes. Abstract in english Background: Suicide is a relevant public health problem in Chile. This is the first Chilean study with the psychological autopsy method (PA). Aims: a) to identify risk factors for suicide in Chilean victims; b) to identify risk indicators for early intervention; c) to assess acceptability of the PA [...] method by informants. Method: Sample consisted of 30 subjects (24 males, six females) who commited suicide in the IV Region of Chile (December 2008-September 2010). Data was collected from informant interviews. Main instrument was the Psychological Autopsy Interview Protocol. Results: Mean age at suicide was 35.8 years. Most victims communicated suicidal intent before consummation. Almost all experienced negative life events, in many cases shortly before suicide. One half had attempted suicide previously, some during the preceding month. Thirty-six percent were in mental health treatments at time of death. A quarter had recently visited mental health professionals. Psychiatric disorders (ICD-10) were identified in 90%, mainly depressive and substance use disorders. Personality disorders were evident in eight victims (33%): dissocial (4), emotionally unstable (2), paranoid (1), and anxious (avoidant) (1). Conclusions: A high rate of psychiatric disorders was confirmed. Previous suicide attempts are sensitive predictors of completed suicide. Communication of suicide intent is frequent, and may be an opportunity for intervention. Suicide is often preceded by negative life events. Prevention of suicide may be improved by effective treatment of psychiatric disorders, and focused psychosocial interventions. Intensive follow-up of attempters seems highly relevant. PA is an acceptable method for informants.

  3. Misoprostol como abortivo en España: A propósito de un caso de autopsia judicial / Misoprostol as an abortive in Spain: Report of a judicial autopsy case

    Scientific Electronic Library Online (English)

    PM., Garamendi González; MI., Landa Tabuyo.

    2004-10-01

    Full Text Available El Misoprostol es un agente farmacológico introducido en el mercado español bajo la forma de un fármaco protector gástrico y comercializado actualmente en asociación con un antinflamatorio. Desde hace varios años, se desarrolla un debate internacional sobre el hecho de que este mismo producto cumple [...] las características de un abortivo extremadamente eficaz. No obstante, el uso inadecuado del Misoprostol puede causar daños severos a la madre y al feto, tanto si el producto se usa con fines abortivos como si se administra accidentalmente durante una gestación, incluso a las dosis recomendadas. Por otra parte, el Misoprostol tiene un rápido metabolismo y no es fácilmente identificable por los laboratorios toxicológicos de referencia, limitando su posible identificación en casos de uso inadecuado, voluntario o accidental. Se presenta un caso de autopsia médico legal tras un posible episodio de aborto inducido por la administración de Misoprostol. Abstract in english Misoprostol is a drug commercialized in Spain as a gastric protector. Nowadays it is sold in our country also associated with diclofenac to prevent gastric damages produced by anti-inflammatories. During the last few years, there has been a public debate in medical press about the fact that Misopros [...] tol has also proved to be an excellent abortive. Nevertheless, when it is not properly used Misoprostol can be the cause of severe damages to the fetus and the mother. This Prostaglandin E1 analog is a drug rapidly metabolized in humans and it is not easy to identify in toxicological analyses. This is the main bias when trying to identify it in forensic cases of accidental damages after using it as a gastric protector or voluntary administration as an abortive. We present a case report about a forensic autopsy following a possible Misoprostol induced abortion.

  4. Malformações do sistema nervoso central: análise de 157 necrópsias pediátricas / Malformations of the central nervous system: analysis of 157 pediatric autopsies

    Scientific Electronic Library Online (English)

    LÚCIA DE, NORONHA; FABIOLA, MEDEIROS; VANESSA DELLO MÔNACO, MARTINS; GILBERTO ANTUNES, SAMPAIO; MARIA JOSÉ, SERAPIÃO; GILDA, KASTIN; LUIZ FERNANDO BLEGGI, TORRES.

    2000-09-01

    Full Text Available As malformações do sistema nervoso central (SNC) têm sido relatadas como de alta prevalência, acometendo 5 a 10 crianças para 1000 nascidos vivos. Estudamos a frequência das malformações do SNC em 5837 necrópsias pediátricas realizadas no Serviço de Anatomia Patológica do Hospital de Clínicas-UFPR, [...] entre 1960 e 1995. Encontraram-se 157 malformações do SNC, correspondendo a 2,69% das necrópsias. As malformações mais comuns foram os defeitos do tubo neural (61%), incluindo 47 anencefalias e 45 casos classificados no grupo das mieloencefaloceles. As anomalias da vesícula prosencefálica foram responsáveis por 8% das malformações encefálicas, havendo sete casos de holoprosencefalia. Em 3%, as alterações ocorreram na fossa posterior, com três malformações de Arnold-Chiari. No presente estudo, os índices de mortalidade por malformações do SNC foram mais altos no período neonatal. Abstract in english The malformations of the central nervous system affect about 5 to 10 children per 1000 births. We studied the central nervous system malformations in 5837 pediatric autopsies performed in the Sector of Anatomic Pathology, Hospital de Clínicas-UFPR, between 1960 and 1995. There were 157 central nervo [...] us system malformations (2.69%), the commonest were neural tube defects (61%): 47 cases of anencephaly and 45 cases classified in the group of myeloencephaloceles. The anomalies of the prosencephalic evagination corresponded to 8% of all central nervous system malformations, with seven cases of holoprosencephaly. Posterior fossa malformations occurred in 3%, with three cases of Arnold-Chiari. In the present study, the mortality rate due to central nervous system malformations was higher in the neonatal period.

  5. Malformações do sistema nervoso central: análise de 157 necrópsias pediátricas Malformations of the central nervous system: analysis of 157 pediatric autopsies

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    LÚCIA DE NORONHA

    2000-09-01

    Full Text Available As malformações do sistema nervoso central (SNC têm sido relatadas como de alta prevalência, acometendo 5 a 10 crianças para 1000 nascidos vivos. Estudamos a frequência das malformações do SNC em 5837 necrópsias pediátricas realizadas no Serviço de Anatomia Patológica do Hospital de Clínicas-UFPR, entre 1960 e 1995. Encontraram-se 157 malformações do SNC, correspondendo a 2,69% das necrópsias. As malformações mais comuns foram os defeitos do tubo neural (61%, incluindo 47 anencefalias e 45 casos classificados no grupo das mieloencefaloceles. As anomalias da vesícula prosencefálica foram responsáveis por 8% das malformações encefálicas, havendo sete casos de holoprosencefalia. Em 3%, as alterações ocorreram na fossa posterior, com três malformações de Arnold-Chiari. No presente estudo, os índices de mortalidade por malformações do SNC foram mais altos no período neonatal.The malformations of the central nervous system affect about 5 to 10 children per 1000 births. We studied the central nervous system malformations in 5837 pediatric autopsies performed in the Sector of Anatomic Pathology, Hospital de Clínicas-UFPR, between 1960 and 1995. There were 157 central nervous system malformations (2.69%, the commonest were neural tube defects (61%: 47 cases of anencephaly and 45 cases classified in the group of myeloencephaloceles. The anomalies of the prosencephalic evagination corresponded to 8% of all central nervous system malformations, with seven cases of holoprosencephaly. Posterior fossa malformations occurred in 3%, with three cases of Arnold-Chiari. In the present study, the mortality rate due to central nervous system malformations was higher in the neonatal period.

  6. (13)Carbon and (15)nitrogen isotopes in autopsy liver tissue samples from Greenlandic Inuit and Danes: consumption of marine versus terrestrial food

    DEFF Research Database (Denmark)

    Milman, N.; Laursen, J.

    2010-01-01

    Background/Objectives: The content of C-13 and N-15 isotopes is higher in marine than in terrestrial food. C-13 and N-15 in human tissue therefore reflects the relative proportions of marine and terrestrial food consumed by the individual. The objective of this study was to measure C-13 and N-15 in liver tissue from Greenlandic Inuit and Danes. Subjects/Methods: Normal liver tissue was obtained at autopsy in 1992-1994 from 60 Inuit with a median age of 61 years (range 25-83) and in 1986 from 15 ethnic Danes with a median age of 84 years (range 66-93). By sieving, liver tissue was separated in a 'cellular fraction' and a 'connective tissue fraction'. C-13 and N-15 in dry liver tissue was measured on a mass spectrometer. delta C-13 indicates the C-13 content relative to the IAEA-CH-6 reference standard. delta N-15 indicates N-15 content relative to the atmospheric nitrogen reference standard. Results: Inuit: median delta C-13 was -21.2 parts per thousand in cellular and -20.0 parts per thousand in connective tissue fractions (P = 001). Median delta N-15 was 10.6 parts per thousand in both cellular and connective tissue fractions. Body mass index was negatively correlated with delta C-13 in the connective tissue fraction (r(s) = -0.42, P = 0.057). Danes: median delta C-13 was -27.0% in cellular and -24.3% in connective tissue fractions (P = 0.11). Median delta N-15 was 9.5 parts per thousand in cellular and 8.9 parts per thousand in connective tissue fractions (P = 0.5). Inuit had higher delta C-13 than Danes in both cellular and connective tissue fractions (P

  7. Verbal autopsy interpretation: a comparative analysis of the InterVA model versus physician review in determining causes of death in the Nairobi DSS

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    Kyobutungi Catherine

    2010-06-01

    Full Text Available Abstract Background Developing countries generally lack complete vital registration systems that can produce cause of death information for health planning in their populations. As an alternative, verbal autopsy (VA - the process of interviewing family members or caregivers on the circumstances leading to death - is often used by Demographic Surveillance Systems to generate cause of death data. Physician review (PR is the most common method of interpreting VA, but this method is a time- and resource-intensive process and is liable to produce inconsistent results. The aim of this paper is to explore how a computer-based probabilistic model, InterVA, performs in comparison with PR in interpreting VA data in the Nairobi Urban Health and Demographic Surveillance System (NUHDSS. Methods Between August 2002 and December 2008, a total of 1,823 VA interviews were reviewed by physicians in the NUHDSS. Data on these interviews were entered into the InterVA model for interpretation. Cause-specific mortality fractions were then derived from the cause of death data generated by the physicians and by the model. We then estimated the level of agreement between both methods using Kappa statistics. Results The level of agreement between individual causes of death assigned by both methods was only 35% (? = 0.27, 95% CI: 0.25 - 0.30. However, the patterns of mortality as determined by both methods showed a high burden of infectious diseases, including HIV/AIDS, tuberculosis, and pneumonia, in the study population. These mortality patterns are consistent with existing knowledge on the burden of disease in underdeveloped communities in Africa. Conclusions The InterVA model showed promising results as a community-level tool for generating cause of death data from VAs. We recommend further refinement to the model, its adaptation to suit local contexts, and its continued validation with more extensive data from different settings.

  8. Assessing the repeatability of verbal autopsy for determining cause of death: two case studies among women of reproductive age in Burkina Faso and Indonesia

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    Ouédraogo Moctar

    2009-05-01

    Full Text Available Abstract Background Verbal autopsy (VA is an established tool for assessing cause-specific mortality patterns in communities where deaths are not routinely medically certified, and is an important source of data on deaths among the poorer half of the world's population. However, the repeatability of the VA process has never been investigated, even though it is an important factor in its overall validity. This study analyses repeatability in terms of the overall VA process (from interview to cause-specific mortality fractions (CSMF, as well as specifically for interview material and individual causes of death, using data from Burkina Faso and Indonesia. Methods Two series of repeated VA interviews relating to women of reproductive age in Burkina Faso (n = 91 and Indonesia (n = 116 were analysed for repeatability in terms of interview material, individual causes of death and CSMFs. All the VA data were interpreted using the InterVA-M model, which provides 100% intrinsic repeatability for interpretation, and thus eliminated the need to consider variations or repeatability in physician coding. Results The repeatability of the overall VA process from interview to CSMFs was good in both countries. Repeatability was moderate in the interview material, and lower in terms of individual causes of death. Burkinabé data were less repeatable than Indonesian, and repeatability also declined with longer recall periods between the death and interview, particularly after two years. Conclusion While these analyses do not address the validity of the VA process in absolute terms, repeatability is a prerequisite for intrinsic validity. This study thus adds new understanding to the quest for reliable cause of death assessment in communities lacking routine medical certification of deaths, and confirms the status of VA as an important and reliable tool at the community level, but perhaps less so at the individual level.

  9. Hallazgos morfológicos en casos fatales de síndrome cardiopulmonar por hantavirus: Estudio de 7 autopsias Morphological findings in fatal cases of hantavirus cardiopulmonary syndrome: Report of 7 autopsies

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    Pablo Guzmán G

    2010-10-01

    Full Text Available Introducción: El síndrome cardiopulmonar por hantavirus (SCPH es una enfermedad infecciosa aguda, caracterizada por insuficiencia cardio-respiratoria súbita y alta mortalidad, causada por un virus ARN del género Hantavirus, familia Bunyaviridae. Un 15% de los casos chilenos ha sido pesquisado en la Araucanía. Objetivo: Conocer en casos fatales de SCPH, sus características clínicas y morfológicas. Material y Método: Estudio descriptivo-retrospectivo de siete casos fatales con examen postmortem, de SCPH, atendidos entre 1997 y 2009 en el Hospital Regional de Temuco. Resultados: Los casos fueron principalmente pacientes jóvenes, rurales, con un cuadro de compromiso respiratorio progresivo, con leucocitosis, trombopenia e infiltrado pulmonar intersticial bilateral. Los principales hallazgos histopatológicos fueron un acentuado edema pulmonar intra-alveolar e intersticial, con escaso daño epitelial e infiltrado mono-nuclear y leve edema miocárdico con infiltrado mononu-clear. Conclusiones: Los antecedentes epidemiológicos, clínicos y laboratorio permiten sospechar SCPH. En los casos fatales la autopsia permite diferenciar el SCPH de otras patologías similares y aporta tejidos para confirmar el diagnóstico.Introduction: Hantavirus cardiopulmonary syndrome (HCPS is an acute infectious disease characterized by sudden cardiorespiratory failure and high mortality, caused by a RNA virus of the genus Hantavirus, family Bunyaviridae, 15% of Chilean cases have been detected in the Araucania Region. Objective: To determine in fatal cases of HCPS, clinical and morphological characteristics. Materials and Methods: Descriptive-retrospective analysis of seven fatal cases with postmortem study of HCPS, attended between 1997 and 2009 at the Hospital of Temuco, Chile. Results: Cases were young patients from rural areas, and presented as an illness of progressive respiratory failure, with leukocytosis, thrombocytopenia and bilateral interstitial pulmonary infiltrates. Main morphological findings were marked intersticial and intraalveolar pulmonary edema, with minimal epithelial injury and mononuclear cell intersticial infiltrate and mild edematous intersticial inflamatory process. Conclusions: Epidemiological, clinical and laboratory background allow to suspect HCPS. In fatal cases, the autopsy makes possible to discard other similar pathologies and provide tissue for confirmation of the disease.

  10. Hallazgos morfológicos en casos fatales de síndrome cardiopulmonar por hantavirus: Estudio de 7 autopsias / Morphological findings in fatal cases of hantavirus cardiopulmonary syndrome: Report of 7 autopsies

    Scientific Electronic Library Online (English)

    Pablo, Guzmán G; Oscar, Tapia E; Miguel, Villaseca H; Juan, Araya O; Lilia, Antonio P; Bolívar, Lee O; Juan, Roa S.

    2010-10-01

    Full Text Available Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es una enfermedad infecciosa aguda, caracterizada por insuficiencia cardio-respiratoria súbita y alta mortalidad, causada por un virus ARN del género Hantavirus, familia Bunyaviridae. Un 15% de los casos chilenos ha sido pesquisado en la [...] Araucanía. Objetivo: Conocer en casos fatales de SCPH, sus características clínicas y morfológicas. Material y Método: Estudio descriptivo-retrospectivo de siete casos fatales con examen postmortem, de SCPH, atendidos entre 1997 y 2009 en el Hospital Regional de Temuco. Resultados: Los casos fueron principalmente pacientes jóvenes, rurales, con un cuadro de compromiso respiratorio progresivo, con leucocitosis, trombopenia e infiltrado pulmonar intersticial bilateral. Los principales hallazgos histopatológicos fueron un acentuado edema pulmonar intra-alveolar e intersticial, con escaso daño epitelial e infiltrado mono-nuclear y leve edema miocárdico con infiltrado mononu-clear. Conclusiones: Los antecedentes epidemiológicos, clínicos y laboratorio permiten sospechar SCPH. En los casos fatales la autopsia permite diferenciar el SCPH de otras patologías similares y aporta tejidos para confirmar el diagnóstico. Abstract in english Introduction: Hantavirus cardiopulmonary syndrome (HCPS) is an acute infectious disease characterized by sudden cardiorespiratory failure and high mortality, caused by a RNA virus of the genus Hantavirus, family Bunyaviridae, 15% of Chilean cases have been detected in the Araucania Region. Objective [...] : To determine in fatal cases of HCPS, clinical and morphological characteristics. Materials and Methods: Descriptive-retrospective analysis of seven fatal cases with postmortem study of HCPS, attended between 1997 and 2009 at the Hospital of Temuco, Chile. Results: Cases were young patients from rural areas, and presented as an illness of progressive respiratory failure, with leukocytosis, thrombocytopenia and bilateral interstitial pulmonary infiltrates. Main morphological findings were marked intersticial and intraalveolar pulmonary edema, with minimal epithelial injury and mononuclear cell intersticial infiltrate and mild edematous intersticial inflamatory process. Conclusions: Epidemiological, clinical and laboratory background allow to suspect HCPS. In fatal cases, the autopsy makes possible to discard other similar pathologies and provide tissue for confirmation of the disease.

  11. El daño multiorgánico en autopsias realizadas en Cuba en 1994 The multiple organ injury in autopsies carried out in Cuba in 1994

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    José Hurtado de Mendoza Amat

    1997-06-01

    Full Text Available Se exponen las experiencias en el estudio del daño multiorgánico vinculadas al estudio de 17 739 autopsias de adultos fallecidos en Cuba en 1994. El daño multiorgánico ocurrió en el 10 % de los casos. El 47 % procedió de las unidades de cuidados intensivos e intermedios y el 17 % tuvo una estadía hospitalaria menor de 24 horas. Como factores causales más frecuentes se presentaron el daño tisular severo y las infecciones. Los órganos más afectados fueron: bazo, hígado, cerebro, pulmón, tubo digestivo y riñón. Las causas directas de muerte más frecuentes: el propio daño multiorgánico, sus manifestaciones en determinados órganos y las causas que lo producen cuando persisten. Se confirmó que cuando un factor causal desata en el organismo una respuesta inmediata, fundamentalmente inmunológica, que se hace sistémica y produce lesiones características en diversos órganos, ocurre el daño multiorgánico. De acuerdo con su magnitud éste puede producir la muerte inmediata, regresar espontánea o terapéuticamente o manifestarse clínicamente como un síndrome de disfunción múltiple de órganos.The experiences obtained from the study of multiple organ injury linked to the investigation of 17 739 autopsies of adults who died in Cuba in 1994 are exposed. The multiple organ injury was found in 10 % of the cases. 47 % came from the intensive and intermediate care units, whereas 17 % were in hospital less than 24 hours. The severe tissue damage and infections were the most frequent causal factors. The most affected organs were: spleen, liver, brain, lung, digestive tube, and kidney. The most common direct causes of death were: the multiple organ injury itself, its manifestations in certain organs, and its causes when they persist. It was confirmed that the multiple organ injury occurs when a causal factor provokes in the organism an immediate response, mainly immunological, which becomes systemic and produces characteristic lesions in different organs. According to its magnitude, it may cause immediate death, cure spontaneous or therapeutically, or manifest itself clinically as a multiple organ failure syndrome.

  12. El daño multiorgánico en autopsias realizadas en Cuba en 1994 / The multiple organ injury in autopsies carried out in Cuba in 1994

    Scientific Electronic Library Online (English)

    José, Hurtado de Mendoza Amat; Teresita, Montero González; Verónica, Walwyn Salas; Reynaldo, Álvarez Santana.

    1997-06-01

    Full Text Available Se exponen las experiencias en el estudio del daño multiorgánico vinculadas al estudio de 17 739 autopsias de adultos fallecidos en Cuba en 1994. El daño multiorgánico ocurrió en el 10 % de los casos. El 47 % procedió de las unidades de cuidados intensivos e intermedios y el 17 % tuvo una estadía ho [...] spitalaria menor de 24 horas. Como factores causales más frecuentes se presentaron el daño tisular severo y las infecciones. Los órganos más afectados fueron: bazo, hígado, cerebro, pulmón, tubo digestivo y riñón. Las causas directas de muerte más frecuentes: el propio daño multiorgánico, sus manifestaciones en determinados órganos y las causas que lo producen cuando persisten. Se confirmó que cuando un factor causal desata en el organismo una respuesta inmediata, fundamentalmente inmunológica, que se hace sistémica y produce lesiones características en diversos órganos, ocurre el daño multiorgánico. De acuerdo con su magnitud éste puede producir la muerte inmediata, regresar espontánea o terapéuticamente o manifestarse clínicamente como un síndrome de disfunción múltiple de órganos. Abstract in english The experiences obtained from the study of multiple organ injury linked to the investigation of 17 739 autopsies of adults who died in Cuba in 1994 are exposed. The multiple organ injury was found in 10 % of the cases. 47 % came from the intensive and intermediate care units, whereas 17 % were in ho [...] spital less than 24 hours. The severe tissue damage and infections were the most frequent causal factors. The most affected organs were: spleen, liver, brain, lung, digestive tube, and kidney. The most common direct causes of death were: the multiple organ injury itself, its manifestations in certain organs, and its causes when they persist. It was confirmed that the multiple organ injury occurs when a causal factor provokes in the organism an immediate response, mainly immunological, which becomes systemic and produces characteristic lesions in different organs. According to its magnitude, it may cause immediate death, cure spontaneous or therapeutically, or manifest itself clinically as a multiple organ failure syndrome.

  13. [Results of autopsy examination of the knee cartilage of 120 patients dying in the hospital. II. The femoro-tibial joint].

    Science.gov (United States)

    Mitrovic, D; Borda-Iriarte, O; Naveau, B; Stankovic, A; Uzan, M; Quintero, M; Ryckewaert, A

    1989-06-01

    The authors have studied the autopsy results of both tibio-femoral joints in 120 patients: 57 women and 63 men, 112 of whom were over the age of 50. The condylar and tibial cartilages were classified into 5 categories: no lesion (0); slight fissure (I); severe fissure (II); slight deep ulceration (III); large ulceration (in more than 25 p. cent of the cartilage surface) exposing the sub-chondral bone (IV). In 120 patients, the 4 condyles in 58 patients (43.8 p. cent) and both tibio-femoral joints in 51 patients (42.5 p. cent) did not present any degenerative lesions beyond stage I. Stage III and IV cartilaginous lesions are rare before the age of 50. Their frequency suddenly increases after the ages of 70 in women and 80 in men. 44 p. cent of women and 31 p. cent of men presented tibio-femoral cartilaginous lesions of stages II or IV in at least one knee; 15.8 p. cent of women and 4.7 p. cent of men presented tibio-femoral lesions, stage IV, in at least one knee. In 58 p. cent of stage III and IV knee lesions, the menisci were abnormal: atrophic or torn. A menisco-chondrocalcinosis was found in 50 knees (20.8 p. cent of knees) of 28 patients (23.3 p. cent of patients). After the age of 60, the cartilaginous lesions were more severe and more extended in knees with menisco-chondrocalcinosis). PMID:2756315

  14. Lewy body variant of Alzheimer's disease or cerebral type lewy body disease? Two autopsy cases of presenile onset with minimal involvement of the brainstem.

    Science.gov (United States)

    Yokota, Osamu; Tsuchiya, Kuniaki; Uchihara, Toshiki; Ujike, Hiroshi; Terada, Seishi; Takahashi, Mafuyu; Kimura, Yuji; Ishizu, Hideki; Akiyama, Haruhiko; Kuroda, Shigetoshi

    2007-02-01

    Lewy bodies (LB) usually extend from the brainstem to the cerebrum in patients with Parkinson's disease. However, whether the patterns of progression of LB and neuronal loss in Parkinson's disease are identical to those in other Lewy body diseases (LBD) remains unclear. In addition, pathological data on the autonomic nervous system involvement in LBD are limited. We present here the clinicopathological characteristics of two autopsy cases with both Alzheimer's disease and dementia with Lewy bodies (DLB), possibly diagnosed as having Lewy body variant of Alzheimer's disease (LBV/AD). Our patients presented clinically with dementia without parkinsonism. Histopathologically, phosphorylated alpha-synuclein-positive LB and Lewy neurites were abundant in the limbic system, especially in the amygdala, and to a lesser degree, in the neocortex, including the primary motor cortex. The amygdala was also most severely affected by neuronal loss, and the other limbic areas and neocortex were affected to a lesser degree. Despite the existence of a small number of LB and many Lewy neurites, neurons in the brainstem nuclei were relatively well preserved. The Braak stages of concurrent neurofibrillary changes and senile plaques were stage V and C, respectively, in both cases. Tyrosine hydroxylase-positive nerve fibers were relatively well spared in one case examined compared with Parkinson's disease cases. Furthermore, many Lewy neurites immunopositive for phosphorylated a-synuclein were found in the nerve fascicles of the epicardium in one case examined and in Parkinson's disease cases to a lesser degree. These findings suggest that: (i) in at least some LBV/AD cases, the amygdala develops neuronal loss and Lewy-related pathology prior to the brainstem nuclei; and (ii) the depletion of nerves in the heart tissue of LBV/AD is not necessarily complete despite the development of Lewy-related pathology. PMID:17319280

  15. Neurocisticercose: contribuição da necrópsia na consolidação da notificação compulsória em Ribeirão Preto-SP, Brazil / Neurocysticercosis: contribution of autopsies to consolidation of the compulsory notification in Ribeirão Preto-SP, Brazil

    Scientific Electronic Library Online (English)

    LEILA, CHIMELLI; ADRIANA F., LOVALHO; OSVALDO M., TAKAYANAGUI.

    1998-09-01

    Full Text Available O presente estudo tem como objetivo a apresentação dos achados de cisticercose nas necrópsias realizadas no Serviço de Patologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, no período de 1992 a 1997. Das 2522 necrópsias, a neurocisticercose foi detectada em 38 (1,5%) dos [...] casos. Destes, 22 (57,9%) foram diagnosticados apenas na necrópsia enquanto 16 (42,1%) apresentavam exames complementares consistentes com cisticercose. A análise dos prontuários médicos evidenciou que 21 (55,2%) eram neurologicamente assintomáticos e a frequência das diversas manifestações clínicas estava de acordo com os dados da literatura. A elevada frequência de indivíduos assintomáticos detectados apenas através da necrópsia demonstra a importância desta como fonte complementar de dados para a consolidação da notificação compulsória da cisticercose. Embasado nos dados do presente estudo, o atual coeficiente de prevalência da cisticercose no município de Ribeirão Preto é 67 casos/100000 habitantes. Abstract in english Neurocysticercosis is a serious public health problem in several countries of Asia, Africa and Latin America. The objective of the present study is to present autopsy findings of neurocysticercosis in the Pathology Division of the University Hospital, Medical School of Ribeirão Preto, University of [...] São Paulo, from 1992 to 1997. Neurocysticercosis was detected in 38 (1.5%) of 2522 autopsies. In twenty two (57.9%) of these, the diagnosis was made post-mortem, while 16 (42.1%) had a previous diagnosis of cysticercosis based on laboratory and imaging studies. Reviewing the medical records, we found that 21 patients (55.2%) were neurologically asymptomatic, while the various clinical manifestations in the others were in accordance with the literature. The high frequency of asymptomatic individuals detected only post-mortem indicates the importance of autopsies as an additional source of data to consolidate the compulsory notification of cysticercosis. Considering the results of this study, the new coefficient of prevalence of cysticercosis in Ribeirão Preto is 67 cases/100000 inhabitants.

  16. Neurocisticercose: contribuição da necrópsia na consolidação da notificação compulsória em Ribeirão Preto-SP, Brazil Neurocysticercosis: contribution of autopsies to consolidation of the compulsory notification in Ribeirão Preto-SP, Brazil

    Directory of Open Access Journals (Sweden)

    LEILA CHIMELLI

    1998-09-01

    Full Text Available O presente estudo tem como objetivo a apresentação dos achados de cisticercose nas necrópsias realizadas no Serviço de Patologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, no período de 1992 a 1997. Das 2522 necrópsias, a neurocisticercose foi detectada em 38 (1,5% dos casos. Destes, 22 (57,9% foram diagnosticados apenas na necrópsia enquanto 16 (42,1% apresentavam exames complementares consistentes com cisticercose. A análise dos prontuários médicos evidenciou que 21 (55,2% eram neurologicamente assintomáticos e a frequência das diversas manifestações clínicas estava de acordo com os dados da literatura. A elevada frequência de indivíduos assintomáticos detectados apenas através da necrópsia demonstra a importância desta como fonte complementar de dados para a consolidação da notificação compulsória da cisticercose. Embasado nos dados do presente estudo, o atual coeficiente de prevalência da cisticercose no município de Ribeirão Preto é 67 casos/100000 habitantes.Neurocysticercosis is a serious public health problem in several countries of Asia, Africa and Latin America. The objective of the present study is to present autopsy findings of neurocysticercosis in the Pathology Division of the University Hospital, Medical School of Ribeirão Preto, University of São Paulo, from 1992 to 1997. Neurocysticercosis was detected in 38 (1.5% of 2522 autopsies. In twenty two (57.9% of these, the diagnosis was made post-mortem, while 16 (42.1% had a previous diagnosis of cysticercosis based on laboratory and imaging studies. Reviewing the medical records, we found that 21 patients (55.2% were neurologically asymptomatic, while the various clinical manifestations in the others were in accordance with the literature. The high frequency of asymptomatic individuals detected only post-mortem indicates the importance of autopsies as an additional source of data to consolidate the compulsory notification of cysticercosis. Considering the results of this study, the new coefficient of prevalence of cysticercosis in Ribeirão Preto is 67 cases/100000 inhabitants.

  17. Autopsia bucal post-exhumación en víctimas de un desastre masivo: Masacre de la Cárcel de Sabaneta, Maracaibo, Venezuela Post-exhumation buccal autopsy in victims of a massive disaster: the Sabaneta Jail Massacre, Maracaibo, Venezuela

    Directory of Open Access Journals (Sweden)

    J.L. Fereira Paz

    2002-10-01

    Full Text Available Ante la solicitud presentada por los parientes de víctimas no identificadas de la Masacre de la Cárcel de Sabaneta, Maracaibo, Venezuela, un tribunal ordenó la exhumación de cuatro cadáveres, quince días después de haber sido sepultados. Se observó una buena conservación de los restos con apreciable mantenimiento de las estructuras y contornos faciales. Se evidenció que el método de acceso a la cavidad oral empleado en la autopsia bucal pre-inhumación facilitó el abordaje para la autopsia post-exhumación, sin provocar mayor destrucción de los tejidos blandos y permitiendo la correcta manipulación tanto de las estructuras orales como de los dispositivos protésicos aportados como evidencias. En todos los casos se verificó la coincidencia de los datos obtenidos durante la autopsia pre-sepultura. Se concluye que cuando el proceso de inhumación se lleva a cabo siguiendo una adecuada planificación, se facilita una futura recuperación del cadáver cuando esta es requerida para completar el procedimiento de identificación.In view of the petition presented by the relatives of the unidentified victims of the Sabaneta Jail Massacre, Maracaibo, Venezuela, a court ordered the exhumation of four corpses, fifteen days after they were buried. The remains were well preserved, the structure and facial outline were well conserved. It was evidenced that the method of access to the oral cavity employed in the pre-inhumation buccal autopsy facilitated the approach to the post-inhumation autopsy, without causing major destruction of the soft tissues and allowing for the correct manipulation of the oral structures as well as of the prosthetic appliances presented as evidence. In all cases, the coincidence of the data obtained during the pre-burial autopsy was verified. It was concluded that adequate planning of the inhumation process facilitates future recuperation of the bodies when this is required to complete the identification procedure.

  18. The presence of enterovirus, adenovirus, and parvovirus B19 in myocardial tissue samples from autopsies : an evaluation of their frequencies in deceased individuals with myocarditis and in non-inflamed control hearts

    DEFF Research Database (Denmark)

    Nielsen, Trine Skov; Hansen, Jakob

    2014-01-01

    PURPOSE: Multiple viruses have been detected in cardiac tissue, but their role in causing myocarditis remains controversial. Viral diagnostics are increasingly used in forensic medicine, but the interpretation of the results can sometimes be challenging. In this study, we examined the prevalence of adenovirus, enterovirus, and parvovirus B19 (PVB) in myocardial autopsy samples from myocarditis related deaths and in non-inflamed control hearts in an effort to clarify their significance as the causes of myocarditis in a forensic material. METHODS: We collected all autopsy cases diagnosed with myocarditis from 1992 to 2010. Eighty-four suicidal deaths with morphologically normal hearts served as controls. Polymerase chain reaction was used for the detection of the viral genomes (adenovirus, enterovirus, and PVB) in myocardial tissue specimens. The distinction between acute and persistent PVB infection was made by the serological determination of PVB-specific immunoglobulins M and G. RESULTS: PVB was detected in 33 of 112 (29 %) myocarditis cases and 37 of 84 (44 %) control cases. All of the samples were negative for the presence of adenovirus and enterovirus. Serological evidence of an acute PVB infection, determined by the presence of immunoglobulin M, was only present in one case. In the remaining cases, PVB was considered to be a bystander with no or limited association to myocardial inflammation. CONCLUSION: In this study, adenovirus, enterovirus, and PVB were found to be rare causes of myocarditis. The detection of PVB in myocardial autopsy samples most likely represents a persistent infection with no or limited association with myocardial inflammation. The forensic investigation of myocardial inflammation demands a thorough examination, including special attention to non-viral causes and requires a multidisciplinary approach.

  19. Guías para la práctica de la autopsia en casos de muerte súbita cardíaca Guidelines for autopsy investigation of sudden cardiac death

    Directory of Open Access Journals (Sweden)

    C. Basso

    2009-01-01

    Full Text Available A pesar de que la muerte súbita cardíaca es una de las formas más importantes de muerte en los países occidentales, este problema no ha recibido la atención que merece por parte de los patólogos y de los médicos de los sistemas públicos de salud. Se han desarrollado nuevos métodos de prevención de arritmias potencialmente mortales, y el diagnóstico de certeza de las causas de muerte súbita cardíaca es en este momento de particular importancia. Los patólogos son responsables de determinar la causa exacta de la muerte súbita pero existen diferencias considerables en el modo en el que se aborda esta cada vez más compleja tarea. La Asociación Europea de Patología Cardiovascular desarrolló unas guías que representan el estándar mínimo necesario en la práctica habitual de la autopsia para la valoración de la muerte súbita cardíaca, incluyendo no sólo un protocolo para el examen del corazón y el muestreo histopatológico, sino también para la investigación toxicológica y molecular. Nuestras recomendaciones son aplicables a centros médicos universitarios, a hospitales regionales y locales y a todo tipo de Institutos de Medicina Forense. La adopción a lo largo de la Unión Europea de un método uniforme de investigación supondrá la mejora de la práctica habitual, permitirá realizar comparaciones significativas entre distintas comunidades y regiones y, lo que es más importante aún, favorecerá que se monitoricen los patrones de las enfermedades que causan una muerte súbita.Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed, and the accurate diagnosis of the causes of sudden cardiac death is now of particular importance. Pathologists are responsible for determining the precise cause of sudden death but there is considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology developed guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate assessment of sudden cardiac death, including not only a protocol for heart examination and histological sampling, but also for toxicology and molecular investigation. Our recommendations apply to university medical centres, regional and district hospitals and all types of forensic medicine institutes. If a uniform method of investigation is adopted throughout the European Union, this will lead to improvements in standards of practice, allow meaningful comparisons between different communities and regions and, most importantly, permit future trends in the patterns of disease causing sudden death to be monitored.

  20. Autópsia psicológica e psicossocial sobre suicídio de idosos: abordagem metodológica Psychological and psychosocial autopsy on suicide among the elderly: a methodological approach

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    Fátima Gonçalves Cavalcante

    2012-08-01

    Full Text Available O artigo analisa a qualidade e a consistência de um roteiro de entrevista semiestruturada, adaptado para o estudo do suicídio de pessoas idosas e apresenta o método das autópsias psicossociais que resultou da aplicação desse instrumento. O objetivo é demonstrar como o uso da entrevista em profundidade e sua forma de organização e análise de dados foram testados e aperfeiçoados por uma rede de pesquisadores de vários centros de pesquisa do Brasil. O método envolveu a aplicação do instrumento em que se socializou um manual de instruções sobre a coleta, sistematização e análise de dados. A metodologia foi aplicada no estudo de 51 casos de idosos que faleceram por suicídio em dez municípios brasileiros, e permitiu a verificação da consistência do instrumento usado e a aplicabilidade do seu método, durante o processo e ao final, por meio de uma avaliação em rede. O roteiro aperfeiçoado e as instruções para replicá-lo e analisá-lo são aqui apresentados. Os resultados apontam o rigor e a credibilidade dessa abordagem metodológica testada e qualificada de um modo interdisciplinar e interinstitucional.The article analyzes the quality and consistency of a semi-structured interview script, adapted for the study on suicide among elderly people, and presents the psychological and psychosocial autopsy method, which is the result of application of this instrument. The objective is to demonstrate how the in-depth interview and subsequent data organization and analyses were tested and improved by a network of researchers from eight regions in Brazil. Evaluation of the method was conducted before and after the application of the instruments to collect, systematize and analyze the data. This methodology was applied in 51 cases of elderly people who committed suicide in ten Brazilian municipalities. The study did more than just collect data with scientific rigor, since it also verified the consistency of the instrument used and the applicability of the method. The improved script and the instructions of how to apply and analyze it are thus presented here. The results reveal the rigor and credibility of this methodological approach tested and qualified by a multidisciplinary and inter-institutional procedure.

  1. Guías para la práctica de la autopsia en casos de muerte súbita cardíaca / Guidelines for autopsy investigation of sudden cardiac death

    Scientific Electronic Library Online (English)

    C., Basso; M., Burke; P., Fornes; P. J., Gallagher; R. H. de, Gouveia; M., Sheppard; G., Thiene; A., van der Wal.

    2009-01-01

    Full Text Available A pesar de que la muerte súbita cardíaca es una de las formas más importantes de muerte en los países occidentales, este problema no ha recibido la atención que merece por parte de los patólogos y de los médicos de los sistemas públicos de salud. Se han desarrollado nuevos métodos de prevención de a [...] rritmias potencialmente mortales, y el diagnóstico de certeza de las causas de muerte súbita cardíaca es en este momento de particular importancia. Los patólogos son responsables de determinar la causa exacta de la muerte súbita pero existen diferencias considerables en el modo en el que se aborda esta cada vez más compleja tarea. La Asociación Europea de Patología Cardiovascular desarrolló unas guías que representan el estándar mínimo necesario en la práctica habitual de la autopsia para la valoración de la muerte súbita cardíaca, incluyendo no sólo un protocolo para el examen del corazón y el muestreo histopatológico, sino también para la investigación toxicológica y molecular. Nuestras recomendaciones son aplicables a centros médicos universitarios, a hospitales regionales y locales y a todo tipo de Institutos de Medicina Forense. La adopción a lo largo de la Unión Europea de un método uniforme de investigación supondrá la mejora de la práctica habitual, permitirá realizar comparaciones significativas entre distintas comunidades y regiones y, lo que es más importante aún, favorecerá que se monitoricen los patrones de las enfermedades que causan una muerte súbita. Abstract in english Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed, and the accurate diagnosis of t [...] he causes of sudden cardiac death is now of particular importance. Pathologists are responsible for determining the precise cause of sudden death but there is considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology developed guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate assessment of sudden cardiac death, including not only a protocol for heart examination and histological sampling, but also for toxicology and molecular investigation. Our recommendations apply to university medical centres, regional and district hospitals and all types of forensic medicine institutes. If a uniform method of investigation is adopted throughout the European Union, this will lead to improvements in standards of practice, allow meaningful comparisons between different communities and regions and, most importantly, permit future trends in the patterns of disease causing sudden death to be monitored.

  2. Causes of death in two rural demographic surveillance sites in Bangladesh, 2004–2010: automated coding of verbal autopsies using InterVA-4

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    Nurul Alam

    2014-10-01

    Full Text Available Objective: Population-based information on causes of death (CoD by age, sex, and area is critical for countries with limited resources to identify and address key public health issues. This study analysed the demographic surveillance and verbal autopsy (VA data to estimate age- and sex-specific mortality rates and cause-specific mortality fractions in two well-defined rural populations within the demographic surveillance system in Abhoynagar and Mirsarai subdistricts, located in different climatic zones. Design: During 2004–2010, the sample demographic surveillance system registered 1,384 deaths in Abhoynagar and 1,847 deaths in Mirsarai. Trained interviewers interviewed the main caretaker of the deceased with standard VA questionnaires to record signs and symptoms of diseases or conditions that led to death and health care experiences before death. The computer-automated InterVA-4 method was used to analyse VAs to determine probable CoD. Results: Age- and sex-specific death rates revealed a higher neonatal mortality rate in Abhoynagar than Mirsarai, and death rates and sex ratios of male to female death rates were higher in the ages after infancy. Communicable diseases (CDs accounted for 16.7% of all deaths in Abhoynagar and 21.2% in Mirsarai – the difference was due mostly to more deaths from acute respiratory infections, pneumonia, and tuberculosis in Mirsarai. Non-communicable diseases (NCDs accounted for 56.2 and 55.3% of deaths in each subdistrict, respectively, with leading causes being stroke (16.5–19.3%, neoplasms (13.2% each, cardiac diseases (8.9–11.6%, chronic obstructive pulmonary diseases (5.1–6.3%, diseases of the digestive system (3.1–4.1%, and diabetes (2.8–3.5%, together accounting for 49.2–51.2% points of the NCD deaths in the two subdistricts. Injury and other external causes accounted for another 7.5–7.7% deaths, with self-harm being higher among females in Abhoynagar. Conclusions: The computer-automated coding of VA to determine CoD reconfirmed that NCDs were the leading CoD with some differences between the sites. Incorporating VA into the national sample vital registration system can help policy makers to identify the leading CoDs for public health planning.

  3. Aterosclerosis coronaria y daño miocárdico. Estudio de autopsias utilizando el Sistema Aterométrico / Coronary aterosclerosis and myocardial damage. An autopsy material study applying the Atherometric System

    Scientific Electronic Library Online (English)

    Yanira Noalis, Díaz Valdés; Myrna, Moreno Miravalles; Jorge, Bacallao Gallestey; José Emilio, Fernández-Britto Rodríguez.

    2013-03-01

    Full Text Available Introducción: se estudió el corazón y las arterias coronarias epicárdicas derecha (CD), descendente anterior (DA) y circunfleja izquierda (CI) de 472 fallecidos, cuyas necropsias se practicaron en el Hospital Universitario "Dr. Carlos J. Finlay". Objetivos: describir la asociación entre las lesiones [...] ateroscleróticas de las arterias coronarias y las lesiones de fibrosis y necrosis del corazón. Caracterizar las lesiones coronarias y miocárdicas, según la existencia o no de antecedentes de cardiopatía isquémica. Material y Métodos: se realizó análisis cuantitativo y cualitativo de la lesión aterosclerótica utilizando el Sistema Aterométrico (SA). Se practicó un análisis de correlaciones canónicas para evaluar la asociación de la lesión miocárdica con la lesión de las coronarias. Para caracterizar la lesión se emplearon los cosenos del vector lesional que describen la importancia relativa de cada modalidad de lesión. Resultados: hay correlaciones moderadas pero significativas entre las lesiones coronarias y las lesiones miocárdicas. Las placas fibrosas son la lesión predominante, pero las estrías adiposas y las placas graves diferencian mejor a los fallecidos con y sin antecedentes de cardiopatía isquémica. Conclusiones: las estrías adiposas y las placas graves se asocian con las áreas de fibrosis y necrosis en el corazón. En los fallecidos con antecedentes de cardiopatía isquémica hay más placas graves y menos estrías adiposas que en los que no tienen antecedentes. Abstract in english Introduction: the heart and the main epicardiac coronary arteries from 472 autopsies done at the University Hospital Dr. Carlos J. Finlay were analyzed and studied. Objectives: to describe the association between coronary and cardiac lesions. 2.- To characterize coronary and myocardial lesions relat [...] ed to history of ischemic heart disease. Materials and Methods: we performed the quantitative and qualitative analyses as part of the Atherometic System (AS). A canonical correlation analysis was done to assess the association between coronary and myocardial lesion. Cosines of the lesion vector were used to describe and assess the relative importance of each type of lesion. Results: there are moderate but statistically significant correlations between myocardial fibrosis and necrosis, and coronary lesion. Fibrous plaques are the predominant lesion, but fatty streaks and severe plaques are more discriminant between cases with and without history of ischemic heart disease. Conclusions: fatty streaks and severe plaques are associated with the areas of fibrosis and necrosis of the heart. Cases with history of ischemic heart disease have more severe plaques and less fatty streaks than cases without history of ischemic heart disease.

  4. Tumores primarios intracranianos: analise de uma serie de autopsias e biopsias consecutivas Primary intracranial tumors: analysis of a series of consecutive autopsies and biopsies

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    Marco Aurelio Lana-Peixoto

    1981-03-01

    Full Text Available Entre 19.760 autópsias e 72.972 biópsias consecutivas, num período de 41 anos e 4 meses, foram encontrados 294 tumores intracranianos primários representando 74,8% das lesões expansivas intracranianas. Cerca de dois terços destes tumores se localizavam no compartimento supratentorial. Os gliomas foram os tumores mais freqüentemente observados, seguidos pelos meningiomas, adenomas hipofisários, tumores de origem embrionária e tumores vasculares. Na região selar foram diagnosticados 39 tumores, incluindo os tumores intra-selares, supraselares e paraselares. A maior parte destes tumores foi constituída pelos adenomas hipofisários, seguidos pelos craniofaringiomas, meningiomas, cistos epidermóides e teratomas. Setenta e cinco tumores foram verificados em pacientes com idade inferior a 15 anos, sendo a maioria deles na fossa posterior, principalmente no cerebelo. Estes tumores foram representados pelos astrocitomas do cerebelo e tronco encefálico, meduloblastomas e ependimomas do quarto ventrículo. Os dados obtidos foram comparados com as várias séries encontradas na literatura.A retrospective study of primary intracranial tumors found in 19.760 consecutive autopsies and 72.972 consecutive biopsies during a period of over 41 years was carried out. Two hundred and five neoplasms comprising 69,7% of the primary intracranial tumors were located in the supratentorial compartment whereas 84 tumors (28,6% were infratentorial in site. Gliomas constituted the largest group of primary tumors comprising 60,9% of the intracranial primary neoplasms. Most of gliomas were found in the cerebral hemispheres, particularly in the frontal lobes. Of the total number of gliomas 40,2% were astrocytomas, 29,6% glioblastomas, 10,6% ependymomas, 10,1% medulloblasto-mas, 5% oligodendrogliomas and 2,2% choroid plexus papillomas. Meningiomas constituted the second most common primary intracranial tumors being found in 56 cases (19%, most of them in parasagittal region, sphenoid ridge and anterior fossa. In the sella region there were 39 neoplasms including 21 pituitary adenomas, seven meningiomas, five craniopharyngiomas, four epidermoid cysts and two teratomas. Six capillary hemangioblastomas of the cerebellum and two chordomas of the clivus were also found. Sixty-five tumors occurred in patients under 15 years of age, 53,3% of them infratentorial in location - 36% in the cerebellum, 9,3% in the brainstem and 8% in the fourth ventricle. The majority of these tumors were astrocytomas, medulloblastomas and ependymomas. The present data are discussed in relation to other pathological series found in the literature.

  5. Suicide study : a psychological autopsy

    OpenAIRE

    Santos, Jose? Henrique Catarino

    2014-01-01

    RESUMO: O'suicídio'é'atualmente'um'problema'de'saúde'pública.'Estimarse'que'um'milhão'de'pessoas' morra'anualmente'devido'ao'suicídio.'De'acordo'com'diversas'agências'e'organizações'estimar 'que'ocorram'entre'20'a'40'tentativas'de'suicídio'por'cada'suicídio'consumado.'Os'custos'associados'ao'suicídio,'quer'humanos'quer'económicos'são'enormes'e'estendemrse'à'família,'emprego,'economia'e'finanças.'Os'números'oficiais'do'suicídio'em'Portugal'indicam'uma'taxa ligeiramente'ac...

  6. Autopsied case of radiation cystitis

    International Nuclear Information System (INIS)

    A 63-year-old woman was admitted to our hospital with the complaint of gross hematuria due to radiation cystitis that occurred 13 years after radiation therapy of the cervic cancer. Despite of conservative therapy to cease bladder hemorrhage, gross hematuria continued and was further complicated by gastrointestinal bleeding and pyelonephritis. As a consequence of blood loss the patient died. Histopathological examination revealed that the bladder lesion was composed of hemorrhagic, gangrenous cystitis with candida infection and ulcer formation. We would like to make a special note on microembolizations were found in the kidney, the liver, the heart, the lung, the gastrointestinal tract and other organs. It was considered to be the lesion of diseminated intravascular coagulation. (author)

  7. Diagnóstico del origen y la causa de la muerte después de la autopsia médico-legal (Parte II) / Diagnosis of the origin and cause of death after the medico-legal autopsy (Part II)

    Scientific Electronic Library Online (English)

    J.L., Palomo Rando; V., Ramos Medina; E. de la, Cruz Mera; A.M., López Calvo.

    2011-03-01

    Full Text Available Una de las tareas más difíciles en patología forense puede ser determinar, después de la autopsia, el origen y la causa de la muerte cuando dichos extremos no están claros o son discutibles. Una autopsia técnicamente perfecta es condición necesaria pero no suficiente para cumplir adecuadamente esta [...] decisión. En el presente trabajo se delimitan claramente los conceptos de causa y mecanismo de muerte, muerte natural y muerte violenta. Se revisan muchos de los aspectos relacionados con el diagnóstico del origen y la causa de la muerte; especialmente el enfoque actual del valor de la autopsia en el diagnóstico, la interacción entre traumatismo y enfermedad, la doctrina de la causalidad, la utilización de la CIE-10, la llamada etiología médico-legal, la autopsia psicológica, la "autopsia blanca" o negativa y el origen de la muerte por complicaciones de la terapéutica, etc., todos ellos se ilustran con ejemplos de casos representativos. Se discute el limitado papel del patólogo forense en España en la determinación de la denominada etiología médico-legal. Las conclusiones constituyen un conjunto de recomendaciones para el mejor cumplimiento de este trabajo, entre ellas el abandono de las denominadas causas de muerte inaceptables como parada cardiaca, parada cardiorrespiratoria o muerte cerebral, etc., la utilización siempre que sea posible de los diagnósticos de la CIE-10 y del formato del apartado de la causa de la muerte (parte I y II) del modelo internacional de certificado médico de causa de defunción de la OMS. Todo ello como guía breve que facilite un resultado judicial adecuado y aumente la credibilidad del patólogo forense. Abstract in english One of the most difficult tasks in forensic pathology is deciding the origin and the cause of death after the autopsy when those issues are unclear or debatable. A technically perfect autopsy is a necessary but not a sufficient condition to adequately fulfil this decision. The present paper clearly [...] defines the concepts of cause and mechanism of death, natural and violent death. We review many aspects related to the diagnosis of the origin and cause of death, especially the current approach of the value of autopsy in the diagnosis, the interaction between trauma and disease, the doctrine of causation, the use of ICD- 10, the so-called manner of death, the psychological autopsy, the negative autopsy and the origin of death from therapeutic complication, and so on., all of which are illustrated with relevant examples. We also discuss the limited role of the forensic pathologist in Spain in determining the so-called manner of death. The conclusions include(s) a list of recommendations for the best performance of this work, including the abandonment of the so-called unacceptable causes of death -as cardiac arrest, cardiopulmonary arrest or brain death, and so on- and whenever possible the adoption of the classification of ICD-10 and the standard paragraph in which the cause of death is informed (part I and II), as proposed by the WHO international certificate of death. These conclusions intend to be a brief guide to provide a fair judicial outcome and enhance the forensic pathologist's credibility.

  8. Diagnóstico del origen y la causa de la muerte después de la autopsia médico-legal (Parte I) / Diagnosis of the origin and cause of death after the medico-legal autopsy (Part I)

    Scientific Electronic Library Online (English)

    J.L., Palomo Rando; V., Ramos Medina; E. de la, Cruz Mera; A.M., López Calvo.

    2010-12-01

    Full Text Available Una de las tareas más difíciles en patología forense puede ser determinar, después de la autopsia, el origen y la causa de la muerte cuando dichos extremos no están claros o son discutibles. Una autopsia técnicamente perfecta es condición necesaria pero no suficiente para cumplir adecuadamente esta [...] decisión. En el presente trabajo se delimitan claramente los conceptos de causa y mecanismo de muerte, muerte natural y muerte violenta. Se revisan muchos de los aspectos relacionados con el diagnóstico del origen y la causa de la muerte; especialmente el enfoque actual del valor de la autopsia en el diagnóstico, la interacción entre traumatismo y enfermedad, la doctrina de la causalidad, la utilización de la CIE-10, la llamada etiología médico-legal, la autopsia psicológica, la "autopsia blanca" o negativa y el origen de la muerte por complicaciones de la terapéutica, etc., todos ellos se ilustran con ejemplos de casos representativos. Se discute el limitado papel del patólogo forense en España en la determinación de la denominada etiología médico-legal. Las conclusiones constituyen un conjunto de recomendaciones para el mejor cumplimiento de este trabajo, entre ellas el abandono de las denominadas causas de muerte inaceptables como parada cardiaca, parada cardiorrespiratoria o muerte cerebral, etc., la utilización siempre que sea posible de los diagnósticos de la CIE-10 y del formato del apartado de la causa de la muerte (parte I y II) del modelo internacional de certificado médico de causa de defunción de la OMS. Todo ello como guía breve que facilite un resultado judicial adecuado y aumente la credibilidad del patólogo forense. Abstract in english One of the most difficult tasks in forensic pathology is deciding the origin and the cause of death after the autopsy when those issues are unclear or debatable. A technically perfect autopsy is a necessary but not a sufficient condition to adequately fulfil this decision. The present paper clearly [...] defines the concepts of cause and mechanism of death, natural and violent death. We review many aspects related to the diagnosis of the origin and cause of death, especially the current approach of the value of autopsy in the diagnosis, the interaction between trauma and disease, the doctrine of causation, the use of ICD- 10, the so-called manner of death, the psychological autopsy, the negative autopsy and the origin of death from therapeutic complication, and so on., all of which are illustrated with relevant examples. We also discuss the limited role of the forensic pathologist in Spain in determining the so-called manner of death. The conclusions include(s) a list of recommendations for the best performance of this work, including the abandonment of the so-called unacceptable causes of death -as cardiac arrest, cardiopulmonary arrest or brain death, and so on- and whenever possible the adoption of the classification of ICD-10 and the standard paragraph in which the cause of death is informed (part I and II), as proposed by the WHO international certificate of death. These conclusions intend to be a brief guide to provide a fair judicial outcome and enhance the forensic pathologist´s credibility.

  9. The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994 / La charge de morbidité à Maputo (Mozambique): enregistrement et autopsie des personnes décédées en 1994 / La carga de morbilidad en Maputo (Mozambique), según los registros de defunciones y autopsias de 1994

    Scientific Electronic Library Online (English)

    Martinho, Dgedge; Ana, Novoa; Gloria, Macassa; Jahit, Sacarlal; James, Black; Catherine, Michaud; Julie, Cliff.

    Full Text Available OBJETIVO: Clasificar las causas de defunción en Maputo (Mozambique) empleando los métodos del estudio sobre la Carga Mundial de Morbilidad, a fin de facilitar información a los formuladores de políticas sanitarias y de obtener valores basales para llevar a cabo futuros estudios en Maputo y en capita [...] les de provincia del país. MÉTODO: Se utilizaron datos extraídos del registro de defunciones y los registros de autopsias de Maputo correspondientes a 1994. RESULTADOS: En el registro de defunciones se habían consignado en total 9011 fallecimientos, lo que representaba una cobertura de aproximadamente el 86%. De esas defunciones, 8114 (92%) estaban clasificadas por causas. Los trastornos transmisibles, maternos, perinatales y nutricionales, eran la causa de 5319 muertes; las enfermedades no transmisibles, de 1834; y los traumatismos, de 961. Las diez causas principales de las defunciones registradas fueron los trastornos perinatales (1643 defunciones); el paludismo (928); las enfermedades diarreicas (814); la tuberculosis (456); las infecciones respiratorias inferiores (416); los accidentes de carretera/tráfico (371); la anemia (269); las enfermedades cerebrovasculares (269); los homicidios (188); y las meningitis bacterianas (178). CONCLUSIÓN: Las enfermedades infecciosas de todo tipo, los traumatismos y las enfermedades cerebrovasculares eran las causas principales de defunción, según demostraban tanto los registros de autopsia como el registro de defunciones de la ciudad. Las muertes relacionadas con el SIDA estaban subnotificadas. Dada la rápida propagación de la infección por el VIH, el SIDA se añadirá a la ya alta carga de enfermedades infecciosas y mortalidad prematura que registra Maputo. Los resultados del estudio indican que la causa de defunción es un valioso indicador de los resultados para los programas de lucha contra las enfermedades. Abstract in english 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 t [...] he 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.

  10. Cerebromeningeal hemorrhage: analysis of autopsies performed over a 10-year period / Hemorragia cerebromeníngea: análise de autópsias em período de 10 anos

    Scientific Electronic Library Online (English)

    Nelson, Martelli; Benedicto Oscar, Colli; João Alberto, Assirati Jr.; Hélio Rubens, Machado.

    1988-06-01

    Full Text Available Foram analisados 353 pacientes que faleceram por hemorragia subaracnóidea autopsiados nos últimos 10 anos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A hemorragia subaracnóidea estava associada a hipertensão arterial em 180 casos, a ruptura de aneurismas em 102 e a outras pa [...] tologias em 71 casos. O sexo masculino predominou nos pacientes com hemorragia associada a hipertensão arterial e o feminino nas hemorragias por ruptura de aneurismas. As hemorragias associadas a hipertensão arterial predominaram em faixas etárias mais altas em relação às hemorragias por aneurismas. Dos pacientes com aneurismas, 36 (35,3%) apresentaram aneurismas no complexo cerebral anterior/comunicante anterior, 30 (29,4%) na carótida interna e 23 (22,5%) na cerebral média. Nos casos de aneurismas, o vasoespasmo predominou no período do 3º ao 10º dia e o ressangramento predominou no período do 9º ao 16º e respectivamente 59,1% e. 61,5% desses pacientes apresentaram-se nos graus I e II na admissão e evoluíram para o grau IV após estas intercorrências. Ambas as intercorrências foram mais freqüentes entre os pacientes com aneurismas do complexo cerebral anterior/comunicante anterior. Sessenta e oito por cento dos óbitos por aneurismas ocorreram nos 9 primeiros dias após a hemorragia. Os pacientes admitidos em grau I e II e que sofreram vasoespasmo ou ressangramento e que poderiam beneficiar-se do tratamento cirúrgico precoce não tiveram esta oportunidade porque a nossa conduta naquela época era de operar sistematicamente no final da segunda ou no início da terceira semana após a hemorragia subaracnóidea. Abstract in english A study was conducted on the medical records of 353 patients who died of a subarachnoid hemorrhage (SAH) and who were submitted to autopsy over the last 10 years. SAH was associated with arterial hypertension in 180 (51%) cases, with ruptured aneurysms in 102 (28.9%), and with other pathologies in 7 [...] 1 (20.1%). The patients with hemorrhage associated with arterial hypertension were mostly males, and those with hemorrhage due to aneurysms were mostly females. Of the patients with aneurysms, 36 (35.3%) had aneurysms in the anterior communicating artery, 30 (29.4%) in the internal carotid artery, and 23 (22.6%) in the middle cerebral artery. Among the patients with aneurysms who suffered rebleeding and vasospasm, 59.1% and 61.5%, respectively, were classified as grade I and II upon admission, and all evolved toward grade IV after these complications, Vasospasm predominated from the 3rd to the 10th day after hemorrhage, and rebleedine from the 9 to 16th day and both were most frequent among patients with aneurysms of the anterior communicant artery. Sixty eight percent of the patients with aneurysms died during the first 9 days after hemorrhage. Because of our conduct was to operate systematically late, a considerable number of patients lost the oportunity to be treated surgically with possible favorable evolution due to vasospasm or rebleeding.

  11. Cerebromeningeal hemorrhage: analysis of autopsies performed over a 10-year period Hemorragia cerebromeníngea: análise de autópsias em período de 10 anos

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    Nelson Martelli

    1988-06-01

    Full Text Available A study was conducted on the medical records of 353 patients who died of a subarachnoid hemorrhage (SAH and who were submitted to autopsy over the last 10 years. SAH was associated with arterial hypertension in 180 (51% cases, with ruptured aneurysms in 102 (28.9%, and with other pathologies in 71 (20.1%. The patients with hemorrhage associated with arterial hypertension were mostly males, and those with hemorrhage due to aneurysms were mostly females. Of the patients with aneurysms, 36 (35.3% had aneurysms in the anterior communicating artery, 30 (29.4% in the internal carotid artery, and 23 (22.6% in the middle cerebral artery. Among the patients with aneurysms who suffered rebleeding and vasospasm, 59.1% and 61.5%, respectively, were classified as grade I and II upon admission, and all evolved toward grade IV after these complications, Vasospasm predominated from the 3rd to the 10th day after hemorrhage, and rebleedine from the 9 to 16th day and both were most frequent among patients with aneurysms of the anterior communicant artery. Sixty eight percent of the patients with aneurysms died during the first 9 days after hemorrhage. Because of our conduct was to operate systematically late, a considerable number of patients lost the oportunity to be treated surgically with possible favorable evolution due to vasospasm or rebleeding.Foram analisados 353 pacientes que faleceram por hemorragia subaracnóidea autopsiados nos últimos 10 anos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A hemorragia subaracnóidea estava associada a hipertensão arterial em 180 casos, a ruptura de aneurismas em 102 e a outras patologias em 71 casos. O sexo masculino predominou nos pacientes com hemorragia associada a hipertensão arterial e o feminino nas hemorragias por ruptura de aneurismas. As hemorragias associadas a hipertensão arterial predominaram em faixas etárias mais altas em relação às hemorragias por aneurismas. Dos pacientes com aneurismas, 36 (35,3% apresentaram aneurismas no complexo cerebral anterior/comunicante anterior, 30 (29,4% na carótida interna e 23 (22,5% na cerebral média. Nos casos de aneurismas, o vasoespasmo predominou no período do 3º ao 10º dia e o ressangramento predominou no período do 9º ao 16º e respectivamente 59,1% e. 61,5% desses pacientes apresentaram-se nos graus I e II na admissão e evoluíram para o grau IV após estas intercorrências. Ambas as intercorrências foram mais freqüentes entre os pacientes com aneurismas do complexo cerebral anterior/comunicante anterior. Sessenta e oito por cento dos óbitos por aneurismas ocorreram nos 9 primeiros dias após a hemorragia. Os pacientes admitidos em grau I e II e que sofreram vasoespasmo ou ressangramento e que poderiam beneficiar-se do tratamento cirúrgico precoce não tiveram esta oportunidade porque a nossa conduta naquela época era de operar sistematicamente no final da segunda ou no início da terceira semana após a hemorragia subaracnóidea.

  12. Expresión Morfológica de la Arteria Basilar: Un Estudio con Material de Autopsia de Individuos Colombianos / Morphological Expression of the Basilar Artery: A Study with Colombian Population's Autopsy Material

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    Pedro Luis, Forero; Luis Ernesto, Ballesteros; Luis Miguel, Ramírez.

    1090-10-01

    Full Text Available La arteria basilar (AB) presenta una expresión variable, la cual es determinante en la etiología de eventos clínicos que comprometen el tallo cerebral. El propósito de este trabajo fue determinar la expresión morfológica de la AB en una muestra de población colombiana. Fueron estudiados 100 tallos c [...] erebrales de individuos a quienes se les practicó autopsia en el Institutode Medicina Legal de Bucaramanga. El sistema vertebro-basilar fue perfundido con resina sintética y evaluado los calibres, trayectorias, niveles de origen y finalización de la AB. La AB presentó trayectoria rectilínea en 68%, desviación a la derecha en 12%, sinuosa en 10% y desviación a la izquierda en 10%. La longitud total de la AB fue 30,2 mm DE 4,07 y la longitud con relación al origen de la arteria Cerebelar superior fue 28,1 mm DE 3,84. Los calibres proximal y distal de la AB fueron 3,96 mm DE 0,48 mm y 3,7 mm DE 0,58 respectivamente. Con relación a las arterias de origen de la AB, se observó hipoplasia ( 2 mm) de la arteria vertebral derecha en el 8% y de la arteria vertebral izquierda en el 11% (P = 0,30). Se observó el origen de la AB a tres niveles del surco pontomedular: a nivel en el 43%, por arriba de este en el 30% y por debajo de este surco en 27% de los casos. Las trayectorias sinuosas y desviadas de la AB observadas y la presencia de hipoplasias de la arteria vertebral son ligeramente superiores a los señalados en estudios previos, mientras que su longitud se ubica en un rango medio y su calibre es ligeramente inferior a lo señalado en la literatura. Abstract in english The basilar artery (BA) has a variable expression which is determinant in the etiology of clinical events that compromise the brain stem. The purpose of this study was to determine the morphological expression of BA in a Colombian population sample. We studied 100 brainstems of individuals which und [...] erwent an autopsy at the Instituto de Medicina Legal of Bucaramanga. The vertebra basilar system was perfused with synthetic resin and its calibers, paths, levels of origin and end of the BA were evaluated. The BA presented a rectilinear trajectory in 68%, deviation to the right in 12%, sinuous in 10% and deviation to the left in 10%. The total length of the BA was 30.2 mm SD 4.07, its length in relation to the origin of the superior cerebellar artery was 28.1 mm SD 3.84. The proximal and distal caliber of the BA were 3.96 mm SD 0.48 mm and 3.7 mm SD 0.58 respectively. In relation to the origin arteries of the AB, hypoplasia was observed ( 2 mm) of the right vertebral artery in 8% and the left vertebral artery in 11% (P = 0.30). The origin of BA was observed at different spontomedullary groove levels: at level in 43%, above it in 30% and below it in 27% of the cases. The sinuous and diverted paths from the BA observed and the presence of vertebral artery hypoplasia are slightly higher than those reported in previous studies, while its length is at medium range and its caliber is slightly lower than reported in the literature.

  13. Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study / Alterações morfológicas no sistema digestivo de 93 pacientes infectados pelo vírus da imunodeficiência humana: um estudo de autopsias

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    Lucinda Calheiros, Guimarães; Ana Cristina Araujo Lemos, Silva; Adilha Misson Rua, Micheletti; Everton Nunes Melo, Moura; Mario Leon, Silva-Vergara; Sheila Jorge, Adad.

    2012-04-01

    Full Text Available Envolvimento do sistema digestório em pacientes com síndrome da imunodeficiência adquirida (AIDS) é frequente e muitas alterações nesses pacientes são diagnosticadas apenas à autopsia. Há escassos estudos de autopsia com análise detalhada desse sistema e apenas um deles foi realizado no Brasil. Nest [...] e estudo avaliamos cada segmento do sistema digestório em 93 autopsias consecutivas de indivíduos infectados pelo vírus da imunodeficiência humana (HIV) e a importância dessas lesões para o óbito. Desses, 90 (96,8%) pacientes apresentavam AIDS. Revisamos prontuários médicos, relatórios de autopsias e cortes histológicos da língua ao reto corados pela técnica de hematoxilina-eosina. Quando necessário, analisamos colorações especiais e imuno-histoquímica para pesquisar infecções. Havia lesões no sistema digestório em 73 (78,5%) casos. As alterações mais comuns foram infecciosas: candidíase (42%), citomegalovirose (29%), histoplasmose (11,8%), toxoplasmose (9,7%) e infecção por micobactérias (9,7%). Neoplasias malignas foram raras, presentes em quatro (4,3%) casos (dois sarcomas de Kaposi, um adenocarcinoma gástrico e um carcinoma embrionário metastático). Todos os segmentos apresentaram lesões: língua (48,6%), esôfago (44,8%), estômago (44,7%), intestino grosso (43,2%) e intestino delgado (28,9%). As lesões encontradas foram causa imediata do óbito em cinco (5,4%) casos. Em outros 36 (38,7%) casos a doença básica era sistêmica comprometendo, também, o sistema digestório. Abstract in english Involvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS) is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each [...] segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV) and the importance of these lesions to death. Of these, 90 (96.8%) patients had AIDS. We reviewed medical records, autopsy reports and histological sections from tongue to rectum stained with hematoxylin-eosin. When necessary, we analyzed special stains and immunohistochemistry to investigate infections. There was damage to the digestive system in 73 (78.5%) cases. The most common infections were candidiasis (42%), cytomegalovirus (29%), histoplasmosis (11.8%), toxoplasmosis (9.7%) and mycobacterial infection (9.7%). Malignancies were rare, present in four (4.3%) cases (two Kaposi's sarcoma, one adenocarcinoma and one metastatic embryonal carcinoma). All segments showed lesions: tongue (48.6%), esophagus (44.8%), stomach (44.7%), colon (43.2%) and small intestine (28.9%). The lesions found were immediate cause of death in five (5.4%) cases. In another 36 (38.7%) cases the basic disease was systemic and also compromised the digestive system.

  14. Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study Alterações morfológicas no sistema digestivo de 93 pacientes infectados pelo vírus da imunodeficiência humana: um estudo de autopsias

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    Lucinda Calheiros Guimarães

    2012-04-01

    Full Text Available Involvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV and the importance of these lesions to death. Of these, 90 (96.8% patients had AIDS. We reviewed medical records, autopsy reports and histological sections from tongue to rectum stained with hematoxylin-eosin. When necessary, we analyzed special stains and immunohistochemistry to investigate infections. There was damage to the digestive system in 73 (78.5% cases. The most common infections were candidiasis (42%, cytomegalovirus (29%, histoplasmosis (11.8%, toxoplasmosis (9.7% and mycobacterial infection (9.7%. Malignancies were rare, present in four (4.3% cases (two Kaposi's sarcoma, one adenocarcinoma and one metastatic embryonal carcinoma. All segments showed lesions: tongue (48.6%, esophagus (44.8%, stomach (44.7%, colon (43.2% and small intestine (28.9%. The lesions found were immediate cause of death in five (5.4% cases. In another 36 (38.7% cases the basic disease was systemic and also compromised the digestive system.Envolvimento do sistema digestório em pacientes com síndrome da imunodeficiência adquirida (AIDS é frequente e muitas alterações nesses pacientes são diagnosticadas apenas à autopsia. Há escassos estudos de autopsia com análise detalhada desse sistema e apenas um deles foi realizado no Brasil. Neste estudo avaliamos cada segmento do sistema digestório em 93 autopsias consecutivas de indivíduos infectados pelo vírus da imunodeficiência humana (HIV e a importância dessas lesões para o óbito. Desses, 90 (96,8% pacientes apresentavam AIDS. Revisamos prontuários médicos, relatórios de autopsias e cortes histológicos da língua ao reto corados pela técnica de hematoxilina-eosina. Quando necessário, analisamos colorações especiais e imuno-histoquímica para pesquisar infecções. Havia lesões no sistema digestório em 73 (78,5% casos. As alterações mais comuns foram infecciosas: candidíase (42%, citomegalovirose (29%, histoplasmose (11,8%, toxoplasmose (9,7% e infecção por micobactérias (9,7%. Neoplasias malignas foram raras, presentes em quatro (4,3% casos (dois sarcomas de Kaposi, um adenocarcinoma gástrico e um carcinoma embrionário metastático. Todos os segmentos apresentaram lesões: língua (48,6%, esôfago (44,8%, estômago (44,7%, intestino grosso (43,2% e intestino delgado (28,9%. As lesões encontradas foram causa imediata do óbito em cinco (5,4% casos. Em outros 36 (38,7% casos a doença básica era sistêmica comprometendo, também, o sistema digestório.

  15. Correlación clinicopatológica en pacientes inmunocompetentes con Meningitis tuberculosa, reporte de casos de autopsia en el Hospital Universitario de Santander-Colombia / Clinicopathological correlation in inmunocompetent patients with tuberculous meningitis, autopsy cases report in the Hospital Universitario de Santander-Colombia.

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    Julio Cesar, Mantilla; Carlos Andrés, Buitrago; Jeshar, Arocha; Gustavo, Pradilla.

    2012-04-01

    Full Text Available Introducción: describir tres casos fatales de tuberculosis meníngea y establecer correlación clinicopatológica. Materiales y métodos: revisión de protocolos de autopsia entre enero 1 y junio 30 de 2010 en el Departamento de Patología de la Universidad Industrial de Santander (UIS). Entre 121 protoco [...] los de necropsias se encontraron 3 casos de tuberculosis meníngea, de los cuales se revisaron historias clínicas, preparaciones histopatológicas y fotografías. Resultados: tres casos de adultos con edad promedio de 39 años, sin inmunosupresión con tuberculosis meníngea. Las manifestaciones clínicas fueron cefalea, vómito, fiebre, disartria, compromiso de pares craneales, alteraciones motoras y del estado de conciencia. Conclusiones: la tuberculosis meníngea es la forma más grave de la enfermedad, con desenlace fatal en casos no diagnosticados. El bajo índice de sospecha y la similitud con otras infecciones del sistema nervioso central, no permiten diagnostico precoz ni tratamiento oportuno. Salud UIS 2012; 44 (1): 57-66 Abstract in english Introduction: to describe three fatal cases of tuberculous meningitis and to establish clinical pathological correlation. Materials and methods: Revision of autopsy protocols between 01 january and june 30 of 2010 in the Department of Pathology of the Industrial University of Santander (UIS). Betwee [...] n 121 protocols of autopsies were 3 cases of tuberculous meningitis, of which clinical histories, histopathological slides and photographies were rewieved. Results: three cases of adults with age average of 39 years, without inmunosupresión with tuberculous meningitis. The clinical manifestations were migraine, vomit, fever, disartria, commitment of cranial nerves, motor alterations and disorders of consciousness. Conclusions: the tuberculous meningitis is the most serious form of the disease, with fatal course in nondiagnosed cases. The low index of suspicion and the similarity with other infections of the central nervous system, do not allow early diagnostic and nor opportune treatment. Salud UIS 2012; 44 (1): 57-66

  16. Esplenitis aguda inespecífica como indicador de infección sistémica. Evaluación de 71 casos de Autopsias / Non-Specific acute Splenitis as an indicator of systemic infection. evaluation Of 71 Autopsy cases

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    Gabriel J., Arismendi-Morillo; Alberto E., Briceño-García; Zoila R., Romero-Amaro; Mary C., Fernández-Abreu; Hugo E., Girón-Piña.

    2004-06-01

    Full Text Available Resumen Los textos clásicos de patología plantean que la presencia de esplenitis aguda es reflejo de estados sépticos, pero está poco clara la evidencia en la que se basa tal asociación. Se evaluó la presencia de esplenitis aguda inespecífica como indicador de infección sistémica en casos de autopsi [...] a clínica. Se seleccionaron 34 casos que presentaron síndrome de disfunción de órganos secundario a sepsis como causa de muerte (Grupo A) y 37 casos fallecidos por procesos no infecciosos (Grupo B), de las 145 autopsias clínicas practicadas en el lapso 31 de enero de 1999 - 31 de diciembre de 2000 en el Departamento de Patología del Hospital General del Sur "Dr. Pedro Iturbe" de Maracaibo - Venezuela. El 79% de los casos del grupo A presentó esplenitis aguda mientras que en el grupo B ningún caso la desarrolló (p Abstract in english Abstract Classic pathology textbooks claim that acute splenitis reflects septic states, nevertheless, the evidence upon which that association is based remains unclear. We assessed the occurrence of acute splenitis, as an indicator of systemic infection, in 34 autopsies performed in patients in whom [...] the cause of death was due to multiple organ dysfunction syndrome, secondary to sepsis (group A); and in 37 cases of death by non-infectious causes (group B). These necropsies were done during the period January 31 1999 - December 31 2000, at the Pathology Department of the Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Venezuela. Acute splenitis was observed in 79% of the cases in group A, whereas it was absent in group B (p

  17. Influencia da causa de morte no peso corporal e dos orgaos internos em autopsias perinatais / Influence of cause of death on body and internal organs weight in perinatal autopsies

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    Rosana Rosa Miranda, Correa; Laura Penna, Rocha; Caetano Galvao, Petrini; Vicente de Paula Antunes, Teixeira; Eumenia Costa da Cunha, Castro.

    2014-01-01

    Full Text Available OBJETIVO: Avaliar as variações do peso corporal e dos órgãos internos de crianças autopsiadas no período perinatal e sua relação com a causa de morte. MÉTODOS: Foram incluídos 153 casos de autópsias perinatais realizadas em um hospital universitário do Sudeste do Brasil. Informações sobre caus [...] a de morte perinatal, data da autópsia, idade gestacional, peso perinatal e dos órgãos foram recuperadas dos protocolos de autópsia e do prontuário da mãe e/ou do recém-nascido. Foram definidos quatro grupos de causa de morte: malformações congênitas, hipóxia/anóxia perinatal, infecção ascendente e membrana hialina. Encéfalo, fígado, pulmões, coração, baço, timo e suprarrenais foram analisados. RESULTADOS: O peso das crianças com hipóxia/anóxia perinatal (1.834,6±1.090,1 g versus 1.488 g), membrana hialina (1.607,2±820,1 g versus 1.125 g) e infecção ascendente (1.567,4±1.018,9 g versus 1.230 g) foi maior do que o esperado para a idade gestacional. O peso dos pulmões foi maior nos casos com infecção ascendente (36,6±22,6 g versus 11 g) e menor nos casos com malformação congênita (22,0±9,5 g versus 40 g). O peso do baço foi maior nos casos que apresentaram infecção ascendente (8,6±8,9 g versus 3,75 g ). O peso das suprarrenais foi menor nos casos com malformação congênita (3,9±2,1 g versus 5,5 g), o do timo foi menor nos casos com miscelânea (3,7±1,2 g versus 7,5 g) e o do baço foi menor nos casos com imaturidade pulmonar (0,4±0,1 g versus 1,7 g). Todos esses resultados apresentaram diferenças significativas. CONCLUSÕES: Este estudo demonstra que as variações do peso das crianças e de seus órgãos estão relacionadas aos tipos de causa de morte perinatal. Esses dados podem contribuir para uma melhor interpretação dos achados de autópsia e a sua relação anatomoclínica. Abstract in english PURPOSE: To evaluate changes in body and internal organ weight of autopsied children in the perinatal period and their relationship with the cause of death. METHODS: One hundred and fifty three cases of perinatal autopsies performed at a university hospital in Southeastern Brazil ere included. [...] Information about cause of perinatal death, date of autopsy, gestational age, perinatal weight and organ weight was obtained from the autopsy protocols and medical records of the mother and/or the newborn. Four groups of causes of death were defined: congenital malformations, perinatal hypoxia/anoxia, ascending infection and hyaline membrane. Brain, liver, lungs, heart, spleen, thymus and adrenals were analyzed. RESULTS: The weight of children with perinatal hypoxia/anoxi (1,834.6±1,090.1 g versus 1,488 g), hyaline membranes (1,607.2±820.1 g versus 1,125 g) and ascending infection (1,567.4±1,018.9 g versus 1,230 g) was higher than expected for the population. Lung weight was higher in cases with ascending infection (36.6±22.6 g versus 11 g) and lower in cases with congenital malformations (22.0±9.5 g versus 40 g). Spleen weight was higher in children with ascending infection (8.6±8.9 g versus 3.75 g ) and adrenal weight was lower in cases with congenital malformations (3.9±2.1 g versus 5.5 g). Thymus weight was lower in cases with miscellaneous causes (3.7±1.2 g versus 7.5 g) and spleen weight was lower in patients with lung immaturity (0.4±0.1 g versus 1.7 g). All results showed significant differences. CONCLUSIONS: This study demonstrates that variations in the weight of children and the weight of their organs are related to the types of cause of perinatal death. These data may contribute to a better interpretation of autopsy findings and their anatomical and clinical relationship.

  18. Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model / Evaluation d'une nouvelle manière d'interpréter les autopsies verbales dans une communauté rurale en Ethiopie: le modèle InterVA / Evaluación de un nuevo sistema de interpretación (modelo InterVA) de las autopsias verbales en una comunidad de la Etiopía rural

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    Mesganaw, Fantahun; Edward, Fottrell; Yemane, Berhane; Stig, Wall; Ulf, Högberg; Peter, Byass.

    2006-03-01

    Full Text Available OBJETIVO: La autopsia verbal (AV) -entrevista a miembros de la familia o a cuidadores acerca de las circunstancias de una defunción después del evento- es un instrumento de uso arraigado en las zonas con sistemas inadecuados o inexistentes de registro sistemático de las defunciones. Evaluamos los re [...] sultados de un modelo probabilístico (InterVA) de interpretación de las entrevistas de AV comunitarias, a fin de investigar las pautas de mortalidad por causas específicas en una comunidad etíope rural, y comparamos esos resultados con los obtenidos por médicos locales a los que se dio a examinar las AV, con miras a validar el modelo como instrumento comunitario. MÉTODOS: Se completaron con éxito doscientas ochenta y nueve entrevistas de AV, que incluían la mayor parte de las defunciones ocurridas en una determinada comunidad durante un periodo de un año. Las entrevistas de AV fueron interpretadas por médicos y mediante el modelo, y se procedió a calcular las fracciones de mortalidad por causas específicas para el conjunto de la comunidad y para grupos de edad particulares utilizando los dos sistemas. RESULTADOS: Se observó una buena correlación entre los resultados de los dos sistemas de interpretación en este ejemplo de Etiopía. Cuatro grandes grupos de causas explicaban más del 60% de toda la mortalidad, y los perfiles internos observados en grupos de edad específicos fueron compatibles con lo que podía esperarse para una comunidad subdesarrollada de alta mortalidad del África subsahariana. CONCLUSIÓN: En comparación con la interpretación realizada por médicos, el modelo InterVA requiere mucho menos trabajo y tiene una coherencia del 100%. Es un nuevo y valioso instrumento para caracterizar la distribución de la mortalidad por causas específicas en comunidades sin registros de defunción y para comparar las pautas de mortalidad de distintas poblaciones. Abstract in english OBJECTIVE: Verbal autopsy (VA)- the interviewing of family members or caregivers about the circumstances of a death after the event- is an established tool in areas where routine death registration is non-existent or inadequate. We assessed the performance of a probabilistic model (InterVA) for inte [...] rpreting community-based VA interviews, in order to investigate patterns of cause-specific mortality in a rural Ethiopian community. We compared results with those obtained after review of the VA by local physicians, with a view to validating the model as a community-based tool. METHODS: Two-hundred and eighty-nine VA interviews were successfully completed; these included most deaths occurring in a defined community over a 1-year period. The VA interviews were interpreted by physicians and by the model, and cause-specific mortality fractions were derived for the whole community and for particular age groups using both approaches. FINDINGS: The results of the two approaches to interpretation correlated well in this example from Ethiopia. Four major cause groups accounted for over 60% of all mortality, and patterns within specific age groups were consistent with expectations for an underdeveloped high-mortality community in sub-Saharan Africa. CONCLUSION: Compared with interpretation by physicians, the InterVA model is much less labour intensive and offers 100% consistency. It is a valuable new tool for characterizing patterns of cause-specific mortality in communities without death registration and for comparing patterns of mortality in different populations.

  19. Use of verbal autopsy to determine mortality patterns in an urban slum in Kolkata, India / Utilisation de l'autopsie verbale pour détecter des modèles de mortalité dans un quartier urbain pauvre de Kolkata en Inde / Utilización de las autopsias verbales para determinar las causas de mortalidad en un barrio urbano pobre de Kolkata, India

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    Suman, Kanungo; Ataru, Tsuzuki; Jacqueline L, Deen; Anna Lena, Lopez; Krisnan, Rajendran; Byomkesh, Manna; Dipika, Sur; Deok Ryun, Kim; Vinay Kumar, Gupta; R Leon, Ochiai; Mohammad, Ali; Lorenz, von Seidlein; Sujit K, Bhattacharya; John D, Clemens.

    2010-09-01

    Full Text Available OBJETIVOS: Definir los patrones de mortalidad en un barrio urbano pobre de Kolkata, India, dentro del contexto de un proyecto contra el cólera y la fiebre tifoidea. MÉTODOS: En una población bien definida y sometida a vigilancia durante 18 meses se realizó el seguimiento de un conjunto de 63788 resi [...] dentes, cuyos hogares recibieron visitas mensuales del personal sanitario comunitario para identificar las defunciones. Las entrevistas con los familiares y allegados de las personas fallecidas fueron realizadas por médicos expertos, y los directores médicos atribuyeron la causa principal de la muerte siguiendo la Clasificación Internacional de Enfermedades, 10.a edición. Las causas de la muerte se clasificaron según las categorías de la Carga Mundial de Morbilidad del 2000 y se evaluaron las tasas de mortalidad general y específica de cada caso en función del grupo de edad y del sexo. RESULTADOS: Se registraron 544 muertes durante el seguimiento de 87921 años-persona. Estos datos generaron una tasa de mortalidad de 6,2 por 1000 años-persona. En el 89% de las muertes (482/544) se asignó una causa. Las principales causas de defunción, en orden descendente, fueron: las enfermedades cardiovasculares (fundamentalmente, entre los adultos mayores de 40 años), el cáncer, las enfermedades respiratorias y los trastornos digestivos. La mayoría de las muertes acaecidas en niños menores de cinco años se debieron a la tuberculosis, las infecciones respiratorias y las enfermedades diarreicas. CONCLUSIÓN: Aunque las causas más frecuentes de muerte infantil fueron las infecciosas, en los adultos predominaron las enfermedades infecciosas no contagiosas. Es necesario continuar con las intervenciones contra las enfermedades infecciosas, así como iniciar estrategias nuevas e innovadoras para luchar contra las enfermedades no infecciosas. Abstract in english OBJECTIVE: To define mortality patterns in an urban slum in Kolkata, India, in the context of a cholera and typhoid fever project. METHODS: In a well-defined population that was under surveillance for 18 months, we followed a dynamic cohort of 63788 residents whose households were visited monthly by [...] community health workers to identify deaths. Trained physicians performed verbal autopsies and experienced senior physicians assigned the primary cause of death according to the International classification of diseases, 10th edition. We tabulated causes of death in accordance with Global Burden of Disease 2000 categories and assessed overall and cause-specific mortality rates per age group and gender. FINDINGS: During 87921 person-years of follow-up, we recorded 544 deaths. This gave an overall mortality rate of 6.2 per 1000 person-years. We assigned a cause to 89% (482/544) of the deaths. The leading causes of death, in descending order, were cardiovascular diseases (especially among adults aged over 40 years), cancer, respiratory ailments and digestive disorders. Most deaths in children under 5 years of age were caused by tuberculosis, respiratory infections and diarrhoeal diseases. CONCLUSION: Although the most common causes of death in children were infectious, non-communicable diseases were predominant among adults. There is a need for continuing interventions against infectious diseases in addition to new and innovative strategies to combat non-infectious conditions.

  20. Precisão do diagnóstico clínico da síndrome do desconforto respiratório agudo quando comparado a achados de necropsia / Accuracy of clinical diagnosis of acute respiratory distress syndrome in comparison with autopsy findings

    Scientific Electronic Library Online (English)

    Bruno Valle, Pinheiro; Fabiana Sayuri, Muraoka; Raimunda Violante Campos, Assis; Raul, Lamin; Sérgio Paulo dos Santos, Pinto; Paulo Justiniano, Ribeiro Júnior; Júlio César Abreu de, Oliveira.

    2007-08-01

    Full Text Available OBJETIVO: Comparar a definição de síndrome do desconforto respiratório agudo (SDRA) estabelecida pela American-European Consensus Conference (AECC, Conferência Americano-Européia) com achados de necropsia. MÉTODOS: Avaliaram-se todos os pacientes que morreram na unidade de terapia intensiva do Hospi [...] tal Universitário da Universidade Federal de Juiz de Fora entre 1995 e 2003 e que foram submetidos à necropsia. Seus prontuários foram revisados para estabelecer a presença ou não dos critérios clínicos de SDRA, cujo diagnóstico histológico foi definido pela presença de dano alveolar difuso (DAD). RESULTADOS: No período, 592 pacientes faleceram e 22 foram submetidos à necropsia. Destes, 10 pacientes (45%) preencheram os critérios de SDRA pela AECC e sete (32%) preencheram os critérios histopatológicos de DAD. A sensibilidade da definição clínica foi de 71% (IC95%: 36-92%) e a especificidade foi de 67% (IC95%: 42-85%). Os valores preditivos positivo e negativo foram, respectivamente, 50 e 83%; e as razões de verossimilhança positiva e negativa foram, respectivamente, 2,33 e 0,47. Os achados histopatológicos nos cinco pacientes que preencheram os critérios clínicos de SDRA, mas não apresentavam DAD, foram pneumonia (n = 2), embolia pulmonar (n = 1), tuberculose (n = 1) e criptococose (n = 1). CONCLUSÃO: A precisão dos critérios da AECC para diagnóstico de SDRA não é tão boa. Em função do baixo valor preditivo positivo e da baixa razão de verossimilhança positiva do diagnóstico clínico, outras hipóteses devem ser consideradas quando há suspeita de SDRA. Abstract in english OBJECTIVE: To compare the American-European Consensus Conference (AECC) definition of acute respiratory distress syndrome (ARDS) to autopsy findings. METHODS: All patients who died in the intensive care unit of the Federal University of Juiz de Fora University Hospital between 1995 and 2003 and were [...] submitted to autopsy were included in the study. Patient clinical charts were reviewed to establish whether cases met the AECC criteria for a diagnosis of ARDS, histologically defined as the presence of diffuse alveolar damage (DAD). RESULTS: During the study period, 592 patients died, and 22 were submitted to autopsy. Of those 22 patients, 10 (45%) met the AECC criteria, and 7 (32%) met the histopathological criteria for DAD. The AECC clinical criteria presented a sensitivity of 71% (95%CI: 36-92%) and a specificity of 67% (95%CI: 42-85%). The positive and negative predictive values were, respectively, 50 and 83%, whereas the positive and negative likelihood ratios were, respectively, 2.33 and 0.47. The histopathological findings in the 5 patients who met AECC criteria but did not present DAD were pneumonia (n = 2), pulmonary embolism (n = 1), tuberculosis (n = 1), and cryptococcosis (n = 1). CONCLUSION: The accuracy of the AECC definition of ARDS was godless than satisfactory. Due to the low positive predictive value and the low positive likelihood ratio, other hypotheses must be considered when ARDS is suspected.

  1. Primary lymphoma of the central nervous system: a clinical-pathological and immunohistochemical study of ten autopsy cases Linfoma primário do sistema nervoso central: estudo clínico-patológico e imuno-histoquímico de dez casos de necropsia

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    Henrique Costa

    2006-12-01

    Full Text Available CONTEXT: Primary central nervous system lymphomas (PCNSL are a rare subgroup of lymphomas generally associated with HIV and EBV. OBJECTIVE: To study ten autopsy cases of PCNSL, to describe the neuropathological findings, to characterize the phenotype of the neoplastic cells, to detect EBV in the lesion and to compare the findings with the clinical and laboratory data of the patients. METHOD: The clinical, histological and immunohistochemical data of ten cases of PCNSL, eight cases from patients with AIDS, identified among 265 autopsies of these patients were analyzed. RESULTS: Seven patients were males and the mean age was 40.9 years. The most frequent symptomatology was focal neurologic deficit (70%. Six patients presented with only one lesion. Histologically, densely cellular and polymorphous neoplasms with angiocentrism were observed, in 90% of cases. An association with other diseases was observed in four cases. Most patients had diffuse large B cell non-Hodgkin’s lymphoma. EBV was detected by immunohistochemistry in only one case. The lack of detection of the virus might have been due to the long time of fixation of the brain which might have inactivate epitopes therefore compromising the testing. CONCLUSION: In the present series, PCNSL presented with focal symptoms, with unifocal or multifocal lesions, with a predominant B-cell CD20 positive phenotype, rarely associated with EBV.CONTEXTO: Linfoma primário do sistema nervoso central (LP-SNC é raro subgrupo de linfomas relacionado à AIDS, geralmente associado EBV. OBJETIVO: Identificar os achados clínico-patológicos dos pacientes com LP-SNC. MÉTODO: Foram analisados dados clínicos, histológicos e imuno-histoquímicos de dez necrópsias de LP-SNC, oito deles de pacientes com AIDS, identificados entre 265 autopsias destes. RESULTADOS: Sete pacientes foram masculinos e a idade média foi 40,9 anos. A sintomatologia neurológica mais freqüente era focal (70%. Seis exibiram lesão única. Histologicamente, eram neoplasias densamente celulares e polimorfas, com angiocentrismo em 90% dos casos. Em quatro casos, houve associação com outras afecções. A maioria dos casos foi de linfoma não-Hodgkin difuso de grandes células B. A pesquisa para EBV foi positiva em um caso. CONCLUSÃO: Predominaram os LP-SNC associados à AIDS, com sintomatologia focal, lesão em massa ou multifocal, com predominância de células B CD-20.

  2. Suicide in children and adolescents: A case report of the possible suicide of a 7 year old girl and presentation of data from a forensic autopsy material in Norway

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    Stray-Pedersen Arne

    2014-06-01

    Full Text Available The present paper reports a 7 year old girl’s death by hanging. The forensic investigation disclosed death most likely to be self-inflicted, either an act of suicide, subsidiary a case of accidental asphyxia from a child’s play. A review of forensic autopsy records from southeast Norway during the years 1984-2012 was performed. Totally 116 deaths among children and adolescents < 18 years of age were classified as either suicide or as “undetermined - suicide likely” subsequent to post-mortem examination. The most common suicidal methods were hanging (46%, the use of firearms (24%, jumping in front of a train (11% and drug intake / intoxication (8%. Though rarely observed in children < 12 years of age, suicide is a common cause of sudden death in adolescents, and there is evidence that the extent of the problem is unceasing. The paper highlights the value of forensic medical examination and crime scene reenactment in the evaluation of the manner of death in obscure cases.

  3. La señal aterogénica temprana: estudio multinacional de 4 934 niños y jóvenes y 1 278 autopsias / The early atherogenic signal: a multinational study of 4 934 children and youth and 1 278 autopsies

    Scientific Electronic Library Online (English)

    José Emilio, Fernández-Britto Rodríguez; Aurora, Barriuso Andino; María Teresa, Chiang; Abel, Pereira; Hermes, Toros Xavier; José A, Castillo Herrera; Celia, Bosch Salado; Rosario, Carballo Martínez; Jorge, Bacallao Guerra; Elba, Lima Estévez; Deborah, Sevilla Martínes; María de Jesús, Pla Padrón.

    2005-09-01

    Full Text Available Se presentaron los resultados de 5 investigaciones realizadas en niños y jóvenes, para demostrar que existen desde las primeras edades de la vida una serie de señales aterogénicas tempranas posibles de detectar; las que conocidas obligan a tomar medidas médicas y socioculturales que permitan evitar [...] o retardar el desarrollo de la aterosclerosis. Se estudiaron niños y adolescentes entre 5 y 16 años de 6 escuelas de Ciudad de La Habana, 2 de Panamá, 1 de Concepción, Chile, y 3 de Itapetininga, Brasil. También se investigaron la aorta y la arteria coronaria derecha procedentes de las autopsias de un estudio multinacional dirigido por la Organización Mundial de la Salud, donde participaron 18 países de 4 continentes, se investigaron niños y jóvenes de edades entre 5 y 34 años, todos fallecidos por muerte violenta. Se presentaron los resultados de los estudios patomorfológicos y morfométricos, utilizando el sistema aterométrico . Se estudió el impacto de 3 factores de riesgo, hipertensión arterial, diabetes mellitus tipo 2 y tabaquismo en la producción de lesiones ateroscleróticas. Las conclusiones más relevantes fueron las siguientes: 1. Sí existen suficientes señales aterogénicas tempranas, como hipertensión arterial, obesidad, circunferencia de la cintura exagerada, el índice de masa corporal alterado, tabaquismo activo y pasivo, y los antecedentes patológicos familiares de padecer alguna enfermedad relacionada con la aterosclerosis. 2. Como elementos discriminatorios para la identificación de los niños y jóvenes en los distintos países las variables más relevantes fueron el peso corporal, la circunferencia de la cintura y los valores de tensión arterial sistólica y diastólica. 3. En los estudios de autopsia se pudo demostrar el incremento de áreas de íntima ocupada por lesiones ateroscleróticas con el progreso de la edad y el gran efecto que la hipertensión, la diabetes mellitus tipo 2 y el tabaquismo ejercen en el desarrollo de la aterosclerosis y la transformación de las estrías adiposas en placas fibrosas Abstract in english The results of 5 researches conducted among children and youth were presented to prove that there exists a series of early atherogenic signals since the first ages of life that are possible to detect and that once known oblige to take some medical and sociocultural measures that allow to prevent or [...] delay the development of atherosclerosis. Children and adolescents aged 5-6 from 6 schools of Havana City , 2 from Panama , 1 from Concepción , Chile , and 3 from Itapetininga , Brazil , were studied. The aorta and the right coronary artery from the autopsies of a multinational study directed by the World Health Organization were also investigated. 18 countries from 4 continents took part in this study, in which children and youth aged 5-34 were studied. All of them had had a violent death. The results of the pathomorphological and morphometric studies were presented by using the atherometric system. The impact of 3 risk factors, arterial hypertension, type 2 diabetes mellitus and smoking on the production of atherosclerotic lesions, was studied. The most relevant conclusions were: 1. There are enough early atherogenic signals, such as arterial hypertension, obesity, exaggerated hip circumference, altered body mass index, active and passive smoking and the family pathological history of suffering from some disease related to atherosclerosis. 2. As discriminatory elements for the identification of children and youth in the different countries, the most significant variables were body weight, hip circumference and the values of systolic and diastolic arterial pressure. 3. In the autopsy studies, it was proved the increase of intima areas occupied by atherosclerotic lesions with the progress of age and the great effect that hypertension , type 2 diabetes mellitus and smoking exert on the development of atherosclerosis and the transformation of the adipose striae into fibrous plaques

  4. Infective endocarditis (IE) first diagnosed at autopsy: analysis of 31 cases in Ribeirão Preto, Brazil / Endocardite infecciosa (EI) com diagnóstico feito apenas à necrópsia: análise de 31 casos ocorridos entre 1992 e 1997, em Ribeirão Preto, Brasil

    Scientific Electronic Library Online (English)

    Luiz Tadeu M., FIGUEIREDO; Everaldo, RUIZ-JUNIOR; Tarciso, SCHIRMBECK.

    2001-08-01

    Full Text Available Trinta e um casos fatais de EI, que tiveram este diagnóstico apenas à necrópsia, foram analisados. Os dados clínicos destes pacientes (Grupo 1) mostrou diferenças significantes quando comparados aos de outros 141 casos de EI (Grupo 2). A idade média de 53 anos nos pacientes do Grupo 1 foi 18 anos ma [...] is alta que nos do Grupo 2. Os pacientes do Grupo 1 tiveram uma baixa freqüência de cardiopatias predisponentes à EI. Ambos os grupos de pacientes apresentaram febre (aproximadamente 87%), mas uma significante baixa freqüência de sopro cardíaco (25,8%) foi observado no Grupo 1, provavelmente, em conseqüência disto, o ecocardiograma foi efetuado em apenas 16,1% dos casos, não sendo, portanto, suspeitada EI. Os pacientes do Grupo 1, embora tivessem grave enfermidade aguda, não apresentaram apresentação clínica compatível com EI clássica. Hemoculturas foram feitas em apenas 64,5% dos pacientes do Grupo 1, porém, isolou-se bactérias em 70% e dentre os isolados, predominou o Staphylococcus aureus (71,4%). Foram predominantemente acometidas as válvulas mitral e aórtica. Complicações como embolização e insuficiência cardíaca ocorreram em quase metade dos casos e eles também apresentaram infecções pulmonares, urinárias e do sistema nervoso central. Praticamente todos os casos fatais de EI, que tiveram este diagnóstico apenas à necrópsia, foram submetidos a procedimentos médicos. Sepse aconteceu em aproximadamente metade dos pacientes e mostrou-se acompanhada de choque em mais de 25%. Esta forma de EI deve ser suspeitada em pacientes de idade madura ou idosos, hospitalizados, com doenças que predispõem a infecções, com embolização e que sofreram procedimentos médicos. Abstract in english Thirty one infective endocarditis (IE) fatal cases whose diagnosis was first obtained at autopsy were studied. The clinical data of these patients (Group 1) showed significant differences compared to other 141 IE cases (Group 2). The average age of 53 years in Group 1 patients was 18 years higher th [...] an that of Group 2. The Group 1 patients had a low frequency of IE predisposing heart disease. Both patient groups presented fever (about 87%), but a significant low frequency of cardiac murmur (25.8%) was observed in Group 1 patients and echocardiography tests were performed in only 16.1%, suggesting that IE diagnosis was not suspected. Likewise, although most Group 1 patients appeared with severe acute illness, they did not present the classic IE clinical presentation. Blood cultures were performed in only 64.5% of the Group 1 patients. However, bacteria were isolated in 70% of these blood cultures and Staphylococcus aureus was isolated in 71.4%. The bacteria attacked mitral and aortic valves. Complications such as embolizations and cardiac failure occurred in almost half of the cases and they also presented with infections of the lungs, urinary tract, and central nervous system. Medical procedures were performed in practically all fatal cases whose diagnosis was first obtained at autopsy. Sepsis occurred in about half of the patients and it was followed by shock in more than 25%. This form of IE must be suspected in mature and in old febrile hospitalized patients having infection predisposing diseases, embolization, and suffering medical procedures.

  5. La señal aterogénica temprana: estudio multinacional de 4 934 niños y jóvenes y 1 278 autopsias The early atherogenic signal: a multinational study of 4 934 children and youth and 1 278 autopsies

    Directory of Open Access Journals (Sweden)

    José Emilio Fernández-Britto Rodríguez

    2005-09-01

    Full Text Available Se presentaron los resultados de 5 investigaciones realizadas en niños y jóvenes, para demostrar que existen desde las primeras edades de la vida una serie de señales aterogénicas tempranas posibles de detectar; las que conocidas obligan a tomar medidas médicas y socioculturales que permitan evitar o retardar el desarrollo de la aterosclerosis. Se estudiaron niños y adolescentes entre 5 y 16 años de 6 escuelas de Ciudad de La Habana, 2 de Panamá, 1 de Concepción, Chile, y 3 de Itapetininga, Brasil. También se investigaron la aorta y la arteria coronaria derecha procedentes de las autopsias de un estudio multinacional dirigido por la Organización Mundial de la Salud, donde participaron 18 países de 4 continentes, se investigaron niños y jóvenes de edades entre 5 y 34 años, todos fallecidos por muerte violenta. Se presentaron los resultados de los estudios patomorfológicos y morfométricos, utilizando el sistema aterométrico . Se estudió el impacto de 3 factores de riesgo, hipertensión arterial, diabetes mellitus tipo 2 y tabaquismo en la producción de lesiones ateroscleróticas. Las conclusiones más relevantes fueron las siguientes: 1. Sí existen suficientes señales aterogénicas tempranas, como hipertensión arterial, obesidad, circunferencia de la cintura exagerada, el índice de masa corporal alterado, tabaquismo activo y pasivo, y los antecedentes patológicos familiares de padecer alguna enfermedad relacionada con la aterosclerosis. 2. Como elementos discriminatorios para la identificación de los niños y jóvenes en los distintos países las variables más relevantes fueron el peso corporal, la circunferencia de la cintura y los valores de tensión arterial sistólica y diastólica. 3. En los estudios de autopsia se pudo demostrar el incremento de áreas de íntima ocupada por lesiones ateroscleróticas con el progreso de la edad y el gran efecto que la hipertensión, la diabetes mellitus tipo 2 y el tabaquismo ejercen en el desarrollo de la aterosclerosis y la transformación de las estrías adiposas en placas fibrosasThe results of 5 researches conducted among children and youth were presented to prove that there exists a series of early atherogenic signals since the first ages of life that are possible to detect and that once known oblige to take some medical and sociocultural measures that allow to prevent or delay the development of atherosclerosis. Children and adolescents aged 5-6 from 6 schools of Havana City , 2 from Panama , 1 from Concepción , Chile , and 3 from Itapetininga , Brazil , were studied. The aorta and the right coronary artery from the autopsies of a multinational study directed by the World Health Organization were also investigated. 18 countries from 4 continents took part in this study, in which children and youth aged 5-34 were studied. All of them had had a violent death. The results of the pathomorphological and morphometric studies were presented by using the atherometric system. The impact of 3 risk factors, arterial hypertension, type 2 diabetes mellitus and smoking on the production of atherosclerotic lesions, was studied. The most relevant conclusions were: 1. There are enough early atherogenic signals, such as arterial hypertension, obesity, exaggerated hip circumference, altered body mass index, active and passive smoking and the family pathological history of suffering from some disease related to atherosclerosis. 2. As discriminatory elements for the identification of children and youth in the different countries, the most significant variables were body weight, hip circumference and the values of systolic and diastolic arterial pressure. 3. In the autopsy studies, it was proved the increase of intima areas occupied by atherosclerotic lesions with the progress of age and the great effect that hypertension , type 2 diabetes mellitus and smoking exert on the development of atherosclerosis and the transformation of the adipose striae into fibrous plaques

  6. Comparative study of abnormalities of central nervous system in children and adults autopsied after bone marrow transplantation / Estudo comparativo das alterações no sistema nervoso central de crianças e adultos autopsiados após transplante de medula óssea

    Scientific Electronic Library Online (English)

    Paulo R., Benites Filho; Luis G. M. Pinto de, Almeida; José, Zanis Neto; Ricardo, Pasquini; Luiz F., Bleggi-Torres.

    2007-12-01

    Full Text Available INTRODUÇÃO: Foram comparadas as anormalidades encontradas no sistema nervoso central de adultos e crianças submetidos à autópsia após transplante de medula óssea (TMO) no Departamento de Patologia Médica da Universidade Federal do Paraná (UFPR). MÉTODOS: Relatórios das autópsias de 180 pacientes for [...] am revistos. Foram considerados crianças os pacientes abaixo de 15 anos; adultos, aqueles com 15 ou mais. A idade, o sexo, o diagnóstico clínico na época do TMO, o tempo de sobrevivência, as anormalidades neuropatológicas e a causa da morte foram analisados. RESULTADOS: Nas crianças (26,6% do total) e nos adultos (73,4% do total) o principal diagnóstico clínico prévio ao TMO foi, respectivamente, anemia aplásica severa (31,2%) e leucemia mielóide crônica (36,3%). O tempo médio de sobrevivência pós-TMO para crianças foi de 102,6 dias; para os adultos, 185,9. Lesões cerebrais foram consideradas causa de morte em 20,8% dos casos pediátricos e 11,3% do grupo adulto. As anormalidades neuropatológicas foram morfologicamente similares nas crianças e nos adultos e apresentaram, respectivamente, as seguintes prevalências: doenças cerebrovasculares em 58,3% e 56% (p = 0,8655), neurotoxoplasmose em 6,2% e 3% (p = 0,3856) e infecções em 27 e em 25,7% (p = 0,8489). CONCLUSÕES: As crianças tiveram sobrevida menor, maior número de casos de neurotoxoplasmose e duas vezes mais lesões graves do sistema nervoso central que o grupo adulto. Abstract in english BACKGROUND: We compare neuropathological abnormalities in children and adults after bone marrow transplantation (BMT) by means of autopsy in the Department of Medical Pathology, Universidade Federal do Paraná (UFPR), Brazil. METHODS: Autopsy reports of 180 patients were reviewed. They were divided i [...] n two groups: patients under 15 years old and those 15 or older. Age, gender, clinical diagnosis at time of BMT, survival time, neuropathological abnormalities and cause of death were analyzed. RESULTS: In children (26.6% of total) and in the adult group (73.4% of total), the main clinical diagnoses prior to BMT were, respectively, severe aplastic anemia (31.2%) and chronic myeloid leukemia (36.3%). The mean survival time for children was 102.6 days and for adults, 185.9 days after BMT. Brain lesions were considered cause of death in 20.8% of pediatric cases and 11.3% of the adult group. Neuropathological abnormalities were morphologically similar in children and adults, with the following respectively prevalence: cerebrovascular diseases in 58.3 and 56% (p = 0.8655), neurotoxoplasmosis in 6.2% and 3% (p = 0.3856) and infections in 27 and 25.7% (p = 0.8489). CONCLUSIONS: The pediatric patients had shorter survival than adults, with increasing prevalence of neurotoxoplasmosis, and brain lesions were considered cause of death in twice as many as compared to adult patients.

  7. Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model

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    Carolyne Ndila

    2014-10-01

    Full Text Available Background: The vast majority of deaths in the Kilifi study area are not recorded through official systems of vital registration. As a result, few data are available regarding causes of death in this population. Objective: To describe the causes of death (CODs among residents of all ages within the Kilifi Health and Demographic Surveillance System (KHDSS on the coast of Kenya. Design: Verbal autopsies (VAs were conducted using the 2007 World Health Organization (WHO standard VA questionnaires, and VA data further transformed to align with the 2012 WHO VA instrument. CODs were then determined using the InterVA-4 computer-based probabilistic model. Results: Five thousand one hundred and eighty seven deaths were recorded between January 2008 and December 2011. VA interviews were completed for 4,460 (86% deaths. Neonatal pneumonia and birth asphyxia were the main CODs in neonates; pneumonia and malaria were the main CODs among infants and children aged 1–4, respectively, while HIV/AIDS was the main COD for adult women of reproductive age. Road traffic accidents were more commonly observed among men than women. Stroke and neoplasms were common CODs among the elderly over the age of 65. Conclusions: We have established the main CODs among people of all ages within the area served by the KHDSS on the coast of Kenya using the 2007 WHO VA questionnaire coded using InterVA-4. We hope that our data will allow local health planners to estimate the burden of various diseases and to allocate their limited resources more appropriately.

  8. Autometallographic silver enhancement of zinc sulfide crystals created in cryostat sections from human brain biopsies: a new technique that makes it feasible to demonstrate zinc ions in tissue sections from biopsies and early autopsy material

    DEFF Research Database (Denmark)

    Danscher, Gorm; Juhl, S

    1997-01-01

    We present a new technique that allows zinc ions in synaptic and secretory vesicles of biopsy and early autopsy material (<2 hr post mortem) to be transformed to nanometer-sized zinc sulfide crystal lattices for subsequent autometallographic (AMG) development. Human brain biopsies, or other tissue samples containing zinc-enriched (ZEN) cells, are frozen in liquid nitrogen or by CO2 gas immediately after removal. The tissue blocks are cut in a cryostat and the sections placed on glass slides. The slides are transferred to an H2S exposure chamber placed in a -15 C freezer. After 1-24 hr of gas exposure the sections are removed from the chamber, fixed while thawing, and dehydrated. The sections are then exposed to an AMG developer. AMG causes silver enhancement of zinc sulfide crystal lattices created in the tissues through the H2S exposure, making them visible. It is imperative that the tissues are frozen instantaneously after removal, because loosely bound or free zinc ions start leaving their vesicular compartment soon after death. The AMG technique can, despite inadequate fixation and damage to the tissue caused by freezing, also be used to trace zinc ions at ultrastructural levels, and it is demonstrated that zinc ions in the human neocortex are located in synaptic vesicles. In the few human biopsies analyzed thus far, the light microscopic pattern created by the silver-enhanced ZEN terminals resembles that seen in the neocortex of rat brain. The technique has been applied to cryostat sections from neocortex biopsies of five individuals undergoing brain surgery. Biopsies from three patients resulted in satisfactory AMG-stained sections. Rat brains removed and frozen immediately after decapitation constituted the material on which the present technique was developed. Such material results in an almost uniform high quality of staining, and we found that unexposed sections can be stored for at least 5 months at -80 C without ensuing significant loss of AMG staining intensity.

  9. Factores de riesgo y protectores en el suicidio: un estudio de casos y controles mediante la autopsia psicológica / Risk and protective factors in suicide: a case-control study using the psychological autopsy

    Scientific Electronic Library Online (English)

    José M., Antón-San-Martín; Eduardo, Sánchez-Guerrero; Lucía, Pérez-Costilla; Mª-Teresa, Labajos-Manzanares; Yolanda de, Diego-Otero; Nicolás, Benítez-Parejo; Raquel, Comino-Ballesteros; Emilio, Perea-Milla; Valentín, Ramos-Medina; Amalia, López-Calvo.

    2013-10-01

    Full Text Available Las tasas, los métodos y algunos de los factores de riesgo en el suicidio parecen depender de las diferencias geográficas y culturales, lo que implica la elaboración de estudios en zonas específicas de alto riesgo cara a la implementación de estrategias preventivas. Este estudio busca determinar los [...] factores de riesgo y protectores en el suicidio en la Comarca de Antequera-Málaga (España). Se realiza en un estudio de caso y controles mediante la autopsia psicológica con 40 casos de suicidio y 80 controles poblacionales emparejados en género, edad y zona de residencia. El modelo multivariante hallado está compuesto por los siguientes factores: el presentar antecedentes familiares de suicidio y agregación de desordenes mentales en la familia, un diagnóstico de trastorno de la personalidad y conflictos familiares en el mes previo al suicidio. Estos factores permiten discriminar poblaciones de riesgo cara a la implementación de programas preventivos. Abstract in english Rates, methods and some of the risk factors of suicide seem to depend on geographical and cultural differences, which involve conducting research in specific high-risk areas facing the implementation of preventive strategies. This study seeks to determine the risk and protective factors of suicide i [...] n the region of Antequera-Málaga (Spain). Is performed on a case-control study using the psychological autopsy of 40 cases of suicide and 80 population controls matched on gender, age and area of residence. The multivariate model found is composed of the following factors: the antecedents of suicide and mental disorders aggregate in families, a diagnosis of personality disorder and family conflict in the month prior to suicide. These factors discriminate risk populations facing the implementation of preventive programs.

  10. Correlação entre achados macro e microscópicos em 200 autópsias consecutivas: análise do valor custo/benefício do estudo histopatológico completo das autópsias Relationship between gross and microscopic findings in 200 consecutive autopsies: cost/benefit value of the histopathological study of all organs and systems

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    Leandro Santini Echenique

    2002-07-01

    Full Text Available Introdução: Apesar dos avanços na área da medicina diagnóstica, a discrepância entre os diagnósticos clínicos e os da autópsia tem permanecido em torno de 10-20%. É importante reverter esta tendência por medidas que valorizam a realização e a otimização das autópsias. Objetivos: Comparar prospectivamente os achados macro e microscópicos de 200 autópsias, visando analisar o impacto e a relação custo/benefício do estudo histopatológico de todos os órgãos sobre os diagnósticos provisórios macroscópicos e sobre os laudos finais de encerramento. Metodologia: Analisamos 200 autópsias consecutivas realizadas no Departamento de Patologia da Escola Paulista de Medicina/Unifesp, e avaliamos a concordância e a discordância entre os diagnósticos macroscópicos provisórios e os microscópicos finais. Resultados: Houve concordância entre os diagnósticos macro e microscópicos em 143 casos (71,5% e discordâncias em 22 casos (11%, classificadas como leves em 14 casos (7% e graves em oito casos (4%. Em 35 casos (17,5%, a histopatologia revelou alterações sem expressão macroscópica e cujo diagnóstico final foi histológico. Conclusão: O elevado índice de concordância detectado entre os diagnósticos macro e microscópicos, sendo a maioria das discordâncias classificada como leve, parece indicar que as autópsias podem ser encerradas com estudo histopatológico limitado às alterações macroscópicas mais evidentes, com significativa redução de custo (cerca de R$ 300,00 por autópsia e grande melhoria no retorno, em curto período de tempo, da informação para o corpo clínico da instituição.Background: Despite the development in diagnostic medicine, discrepancy between clinical diagnoses and the ones obtained by autopsy has remained around 10-20%. It is important to revert this tendency by measures that value the realization and optimization of autopsies. Objectives: Prospectively compare gross and microscopic findings of 200 autopsies, viewing to analyze the impact and the cost/benefit value of the histopathological study of all organs over provisory microscopic diagnoses and over enclosure final awards. Methods: We analyzed 200 consecutive autopsies performed at Departamento de Patologia da Escola Paulista de Medicina/Unifesp and evaluated agreement and disagreement between provisory gross diagnoses and final microscopic ones. Results: There was agreement between gross and microscopic findings in 143 cases (71.5% and disagreement in 22 cases (11%, classified as light in 14 cases (7% and serious in eight cases (4%. In 35 cases (17.5%, histopathological study revealed alterations with no gross significance which had final histological diagnosis. Conclusion: The high agreement index detected between gross and microscopic findings, most discrepancies being classified as light, seems to indicate that autopsies may be closed with histopathological study limited to the most evident gross alterations, with significant cost reduction (around R$ 300 per autopsy and great improvement in the return, in a short period of time, of information to the institution clinical staff.

  11. Correlação entre achados macro e microscópicos em 200 autópsias consecutivas: análise do valor custo/benefício do estudo histopatológico completo das autópsias / Relationship between gross and microscopic findings in 200 consecutive autopsies: cost/benefit value of the histopathological study of all organs and systems

    Scientific Electronic Library Online (English)

    Leandro Santini, Echenique; Regina de Arruda, Mello; Luciana Nakao, Odashiro; Marcello, Franco.

    2002-07-01

    Full Text Available Introdução: Apesar dos avanços na área da medicina diagnóstica, a discrepância entre os diagnósticos clínicos e os da autópsia tem permanecido em torno de 10-20%. É importante reverter esta tendência por medidas que valorizam a realização e a otimização das autópsias. Objetivos: Comparar prospectiva [...] mente os achados macro e microscópicos de 200 autópsias, visando analisar o impacto e a relação custo/benefício do estudo histopatológico de todos os órgãos sobre os diagnósticos provisórios macroscópicos e sobre os laudos finais de encerramento. Metodologia: Analisamos 200 autópsias consecutivas realizadas no Departamento de Patologia da Escola Paulista de Medicina/Unifesp, e avaliamos a concordância e a discordância entre os diagnósticos macroscópicos provisórios e os microscópicos finais. Resultados: Houve concordância entre os diagnósticos macro e microscópicos em 143 casos (71,5%) e discordâncias em 22 casos (11%), classificadas como leves em 14 casos (7%) e graves em oito casos (4%). Em 35 casos (17,5%), a histopatologia revelou alterações sem expressão macroscópica e cujo diagnóstico final foi histológico. Conclusão: O elevado índice de concordância detectado entre os diagnósticos macro e microscópicos, sendo a maioria das discordâncias classificada como leve, parece indicar que as autópsias podem ser encerradas com estudo histopatológico limitado às alterações macroscópicas mais evidentes, com significativa redução de custo (cerca de R$ 300,00 por autópsia) e grande melhoria no retorno, em curto período de tempo, da informação para o corpo clínico da instituição. Abstract in english Background: Despite the development in diagnostic medicine, discrepancy between clinical diagnoses and the ones obtained by autopsy has remained around 10-20%. It is important to revert this tendency by measures that value the realization and optimization of autopsies. Objectives: Prospectively comp [...] are gross and microscopic findings of 200 autopsies, viewing to analyze the impact and the cost/benefit value of the histopathological study of all organs over provisory microscopic diagnoses and over enclosure final awards. Methods: We analyzed 200 consecutive autopsies performed at Departamento de Patologia da Escola Paulista de Medicina/Unifesp and evaluated agreement and disagreement between provisory gross diagnoses and final microscopic ones. Results: There was agreement between gross and microscopic findings in 143 cases (71.5%) and disagreement in 22 cases (11%), classified as light in 14 cases (7%) and serious in eight cases (4%). In 35 cases (17.5%), histopathological study revealed alterations with no gross significance which had final histological diagnosis. Conclusion: The high agreement index detected between gross and microscopic findings, most discrepancies being classified as light, seems to indicate that autopsies may be closed with histopathological study limited to the most evident gross alterations, with significant cost reduction (around R$ 300 per autopsy) and great improvement in the return, in a short period of time, of information to the institution clinical staff.

  12. BASES RELIGIOSAS PARA LA REALIZACIÓN DE AUTOPSIAS EN EL JUDAISMO Y EN EL ISLAM / RELIGIOUS GROUNDS IN JUDAISM AND ISLAM FOR PERFORMING AUTOPSIES / BASES RELIGIOSAS PARA A REALIZAÇÃO DE AUTÓPSIAS NO JUDAÍSMO E NO ISLAMISMO

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    Diego Giovanni, Castellanos.

    2011-12-01

    Full Text Available O texto estuda o desafio que a realização de exames post mortem implica para as crenças religiosas no que se refere ao tratamento que se deve dar ao corpo humano. Toma-se como exemplo o debate que esse tipo de práticas médicas provoca dentro do judaísmo e do islamismo. Para isso, explica-se a maneir [...] a na qual é considerada a prática médica dentro da lei religiosa, Halakha no judaísmo e Sharia no islamismo, assim como as disposições desta a respeito da morte e dos rituais funerários. Em seguida, analisam-se os esforços de ambas as religiões para integrar os aspectos positivos da realização de autópsias, ainda que limitando seu uso e extensão a circunstâncias particulares. Pretende-se mostrar que as religiões constituem sistemas dinâmicos adaptáveis diante das mudanças das sociedades contemporâneas. Abstract in spanish El texto estudia el desafío que la realización de exámenes post mórtem implica para las creencias religiosas en lo relativo al trato que debe darse al cuerpo humano. Se toma como ejemplo el debate que este tipo de prácticas médicas ha suscitado dentro del judaísmo y el islam. Para esto se explica la [...] manera en la que es considerada la práctica médica dentro de la ley religiosa, Halakha en el judaísmo y Sharia en el islam; así como las disposiciones de esta respecto a la muerte y los rituales funerarios. A continuación se analizan los esfuerzos de ambas religiones por integrar los aspectos positivos de la realización de autopsias, si bien limitando su uso y extensión a circunstancias particulares. Se pretende mostrar que en la ética médica se deberían considerar aspectos tales como los valores religiosos de los pacientes. También se busca mostrar que las religiones constituyen sistemas dinámicos adaptables frente a los cambios de las sociedades contemporáneas. Abstract in english This article examines the challenge post mortem examinations imply for religious beliefs with respect to how the human body should be treated. The debate practices of this type have sparked among believers of both faiths is used as an example to show how the role of medicine is regarded in Jewish an [...] d Islamic law (Halakhah and Sharia) and the respective provisions concerning death and burial rituals. The efforts of both religions to integrate the positive aspects of autopsies, while limiting their use and extension to certain specific circumstances, are analyzed as well. In doing so, the objective is to demonstrate that medical ethics should take into account issues such as the patient's religious beliefs. The authors also attempt to show that religions are dynamic systems capable of adapting to the changes in contemporary societies.

  13. Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death / Avaliação morfológica da membrana basal das cordas vocais de adultos autopsiados e sua correlação com as causas de óbito

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    Ana Karina Marques, Salge; Eumenia Costa da Cunha, Castro; Mara Lúcia Fonseca, Ferraz; Marlene Antônia dos, Reis; Vicente de Paula Antunes, Teixeira.

    Full Text Available OBJETIVO: O objetivo deste trabalho foi identificar as possíveis alterações na espessura da membrana basal das cordas vocais e relacionar estas com a causa de morte. MÉTODO: Foram utilizadas laringes coletadas de adultos autopsiados, no período de 1993 até 2001. Realizamos as colorações da Hematoxil [...] ina- Eosina e Ácido Periódico de Schiff, onde foi medido o diâmetro da membrana basal. RESULTADOS: Foram analisadas 66 cordas vocais, o espessamento foi identificado em 14 casos (21,2%), sendo encontrado em proporções iguais entre os sexos, sendo freqüente em pacientes da cor branca (12 casos, 85,7%). Foram encontradas alterações respiratórias em 10 (71,4%) dos casos com espessamento. Entre os pacientes intubados, 7 (18,4%) apresentaram espessamento. Entre os fumantes 9 (19,63%) apresentavam espessamento. Não houve influência estatisticamente significativa do espessamento na doença que levou o indivíduo à morte. CONCLUSÃO: Em relação a causa de morte não há diferença estatisticamente significante entre os casos cuja causa de morte foi por doenças respiratórias ou por doenças não respiratórias e o diagnóstico de espessamento da membrana basal das cordas vocais. Sua etiopatogênese necessita de maiores estudos. Abstract in english PURPOSE: The purpose of this study was to identify the possible alteration in the thickness of the epithelium basal membrane of the vocal cords and correlate it with the cause of death. METHOD: Larynxes collected from adult autopsies during the period of 1993 to 2001 were utilized. We used the hemat [...] oxylin-eosin and periodic acid-Schiff staining methods for the morphological and morphometric analysis. RESULTS: Sixty-six vocal cords were analysed; increased thickness was identified in 14 cases (21.2%), with equal proportions between the genders. Increased vocal-cord thickness was more frequent in patients of the white ethnicity (12 cases, 85.7%). Respiratory alterations were found in 10 (71.4%) of the cases with increased vocal-cord thickness. Of the patients that were maintained with mechanical ventilation before death, 7 (18.4%) had thickening of the basal membrane. Among the smokers, 9 (19.63%) had basal membrane thickening. CONCLUSION: No statistically significant differences were found between the cases in which the cause of death was related to respiratory diseases as compared to non-respiratory diseases and the thickening of the basal membrane of the vocal cords. However, new studies are needed in order to verify the etiopathogenesis of this thickening.

  14. Eventos vitales adversos y suicidio: un estudio de autopsia psicológica en Medellín, Colombia / Adverse Life Events and Suicide: A Case-Control Study of Psychological Autopsy in Medellin, Colombia

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    Jenny, García-Valencia; Carlos, Palacio-Acosta; Johanna, Diago; Claudia, Zapata; Gabriel, López; Juan, Ortiz; María, López.

    2008-03-01

    Full Text Available Resumen Objetivo: Determinar si tipos específicos de eventos vitales constituyen de manera independiente factores de riesgo para el suicidio en Medellín, Colombia. Método: Estudio de casos y controles donde se tomaron 108 sujetos que fallecieron por suicidio (casos) y 108 que habían muerto por otras [...] causas (controles). Se equiparó por edad y sexo. Tanto en casos como en controles se aplicó la autopsia psicológica y se recolectó información sobre eventos vitales adversos en los seis meses previos a la muerte. Resultados: Al ajustar por la presencia de trastornos psiquiátricos, intentos previos de suicidio y antecedentes familiares de suicidio en el análisis de regresión logística condicional, los eventos que mostraron ser factores que aumentan el riesgo de suicidio fueron: ruptura con la pareja afectiva, desempleo, y con un alto OR, pero sin ser estadísticamente significativo, dificultades económicas. Dada la imprecisión de los resultados, un análisis no condicional mostró que los eventos adversos asociados de manera independiente con suicidio fueron: ruptura con la pareja afectiva y dificultades económicas. Conclusiones: Los eventos vitales adversos ruptura con la pareja afectiva, difi- cultades económicas y desempleo aumentan el riesgo de suicidio, independientemente de la presencia de otros factores. Dichos eventos deben tenerse en cuenta tanto en el diseño de estrategias de prevención y en las políticas de salud mental. Abstract in english Objective: To determine whether specific types of adverse life events are risk factors for suicide in Medellin, Colombia. Method: This is a case-control study conducted among 108 individuals who committed suicide (cases) and 108 deceased from other causes (controls) matched by age and gender. Both c [...] ases and controls were examined through psychological autopsy and information about adverse life events during the previous six months was collected. Results: After adjusting for psychiatric disorders, previous suicide attempts and family history of suicide using a conditional logistic regression analysis, partnership dissolution, and unemployment were found to be risk factors for suicide. Additionally, financial difficulties showed a high OR although it was not statistically significant. Since results lacked precision, we fitted a non-conditional model which pointed to the following events as independent risk factors for suicide: partnership dissolution and separation, and financial difficulties. Conclusions: Partnership dissolution, unemployment, and financial difficulties increase risk of suicide, regardless of other factors. These adverse life events must be taken into account for the design of prevention strategies and mental health policies.

  15. Identificação de agentes infecciosos pulmonares em autópsias de pacientes com a síndrome da imunodeficiência adquirida Identification of infectious agents in the lungs in autopsies of patients with acquired immunodeficiency syndrome

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    Sanivia Aparecida de Lima Pereira

    2002-12-01

    Full Text Available As afecções pulmonares são freqüentes em indivíduos infectados pelo vírus da imunodeficiência humana. Neste trabalho, procurou-se identificar através de histoquímica e imunohistoquímica, agentes infecciosos nos pulmões de indivíduos portadores da síndrome da imunodeficiência adquirida (SIDA, autopsiados entre março de 1990 e julho de 2000 na FMTM. Fragmentos de pulmão de 40 indivíduos com SIDA autopsiados foram analisados histologicamente. Foram identificados agentes infecciosos em 34 (85% casos dos 40 analisados, sendo que bactérias foram encontradas em 22 (55% casos. Entre os agentes fúngicos o Pneumocystis carinii foi encontrado em oito (19,1% casos; Cryptococcus sp em quatro (9,5%, Histoplasma sp em dois (4,8% e Candida sp em um (2,4% caso. Detectou-se também associação entre Pneumocystis carinii, Citomegalovirus e Cryptococcus sp; CMV e Toxoplasma gondii. Em cinco casos, Candida sp, CMV e Pneumocystis carinii estiveram associados a bactérias. Entre as infecções não bacterianas, os fungos foram os agentes infecciosos mais isolados dos pulmões em autópsias de indivíduos com SIDA, sendo o Pneumocystis carinii o mais freqüente.Lung diseases are frequently observed in individuals infected with HIV. The aim of this study was to identify infectious agents in the lungs in the autopsied individuals with AIDS performed between march 1990 and july 2000 at the school of medicine (Uberaba- Brazil, using histochemical and immunohistochemical techniques. Analysis was made on lungs obtained from 40 individuals with AIDS. Infectious agents were observed in 34 (85% cases of the 40 analyzed. Regarding fungis, Pneumocystis carinii was found in 8 (19.1%cases; Cryptococcus sp in 4 (9.5%cases, Histoplasma sp in 2 (4.8%cases and Candida sp in 1 (2.4%case. Association of Pneumocystis carinii, Citomegalovirus and Cryptococcus sp, was observed in one case, and in another, the association of CMV, and Toxoplasma gondii. There were 5 cases with Candida sp, CMV and Pneumocystis carinii associated with bacteria. In conclusion, this study shows that following bacterial agents fungi were the second most common infectious agents in post mortem examination of the lungs from patients with AIDS, being Pneumocystis carinii the most prevalent.

  16. Anthrax Meningitis - Report Of An Autopsied Case

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    Mahadevan A

    1999-01-01

    Full Text Available Anthrax is a rare cause of hemorrhagic meningitis in man. This report illustrates the characteristic hemorrhagic manifestations in the brain of a patient dying of anthrax meningitis secondary to overwhelming bacteremia. Gross examination of the brain revealed a thick dense subarachnoid hemorrhage with numerous petechial hemorrhages in the cortex. Histologically, meningoencephalitis with vascular necrosis, edema, perivascular cortical hemorrhages and clumps of Gram positive bacilli in the vascular lumen and invading vessel wall were the salient features. The anthrax bacillus was isolated from CSF and brain tissue and further its pathogenecity was confirmed by animal inoculation.

  17. Intrathoracic gastric volvulus: an autopsy case report

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    Cristiane Rúbia Ferreira

    2013-06-01

    Full Text Available First described by Berti in 1866, gastric volvulus (GV is an uncommon and potentially lethal entity. GV occurs when the stomach twists by more than 180º resulting in obstruction of the alimentary tract, visceral ischemia, necrosis, and perforation. It is classified according to the rotation axis in organoaxial, mesenteroaxial or a combination of both. The clinical presentation can be acute, and is usually severe or chronic, which sometimes may be asymptomatic. It predominantly occurs in the fifth decade of life, but children, mainly those under the age of 1 year, may be affected. No ethnicity or gender was observed to show predominance. This entity is related to gastric, diaphragmatic disorders as well as laxity of gastric ligaments. Acute GV may complicate with incarceration and strangulation of the stomach when gastric necrosis ensues. These cases show a mortality rate of 60%. The authors report the fatal case of a surgically treated GV in a 43-year-old female patient who looked for medical care only after 1 month of initial symptoms. Diagnosis was confirmed with a thoracic and abdominal axial computed tomography. Besides the entire stomach being herniated and twisted into the thoracic cavity, the pancreas was pulled up through the hiatal orifice, provoking acute pancreatitis. Because of gastric necrosis and perforation, gastroenteric fluid drained into the mediastinum and left pleural space. The postoperative outcome was unfavorable resulting in the patient’s death. The authors call attention to the severeness of the disease, and therefore the need of precocity of diagnosis and surgical treatment.

  18. Peso dos ventrículos cardíacos determinado em necropsia de indivíduos saudáveis mortos por causas externas Cardiac ventricular weights recorded at the autopsy of healthy subjects who died of external causes

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    Sérgio Lamêgo Rodrigues

    2007-11-01

    Full Text Available OBJETIVO: Determinar o peso dos ventrículos cardíacos em necropsia de indivíduos sadios vítimas de morte acidental, visando determinar padrões de normalidade em nossa população. MÉTODOS: Foram examinados 94 corações no Instituto Médico Legal de Vitória. Após remoção do coração e ressecção dos átrios e gordura epicárdica, os ventrículos direito (VD e esquerdo (VE, incluindo o septo, foram separados e pesados e a massa indexada pela altura. O teste de Kolmogorov-Smirnov foi usado para testar normalidade da distribuição. Os dados são apresentados como média ± desvio padrão. RESULTADOS: Após 12 exclusões (doença cardiovascular possível detectada após a morte foram analisados 82 corações (52 homens e 30 mulheres, 16-68 anos, média 31±12 anos. O peso do VE foi de 181±25 g e 125±15 g, do VD foi de 54±7 g e 38±6 g e a massa de VE indexada pela altura foi de 105±14 g/m e 78±8 g/m para homens e mulheres, respectivamente. O P95 do peso do VE foi de 218 g e 128 g/m em homens e 148 g e 88 g/m em mulheres. Não detectamos correlação significante entre a massa ventricular e idade. CONCLUSÃO: O peso do ventrículo esquerdo do coração dos homens da nossa amostra foi superior aos relatados na literatura contemporânea. Nossos resultados sugerem que a presença de hipertrofia de VE pode ser inferida em presença de massa de VE superior a 218 g ou 128 g/m nos homens e 148 g ou 88 g/m nas mulheres.OBJECTIVE:To establish cardiac ventricular weights recorded during the autopsy of healthy individuals who died of external causes, aiming at determining normality patterns in our population. METHODS:A total of 94 hearts were evaluated at the Forensics Department of the city of Vitória, Espírito Santo. After the heart removal and resection of the atria and epicardial fat, the right ventricle (RV and the left ventricle (LV, including the septum, were separated and weighed and the mass was indexed by the height. The Kolmogorov-Smirnov test was used to test the normality of the distribution. Data are presented as means± SD. RESULTS:After the exclusion of 12 hearts (possible cardiovascular disease detected post-mortem 82 hearts were examined (52 males and 30 females, aged 16-68 yrs, 31±12 yrs. The weight of the LV was 181±25 g and 125±15 g, and the weight of the RV was 54±7 g and 38±6 g; the LV mass indexed by height was 105±14 g/m and 78±8 g/m, for males and females, respectively. The P95 of the LV weight was 218 g and 128 g/m in males and 148 g and 88 g/m in females. No significant correlation between ventricular mass and age was observed. CONCLUSION:The weight of the LV in the males from our sample was higher than that reported in the contemporary literature. Our results suggest that the presence of LV hypertrophy can be inferred in the presence of LV mass > 218 g or 128 g/m in males and 148 g or 88 g/m in females.

  19. Precisión del certificado de defunción comparado con la autopsia verbal: Estudio PRISMA / Accuracy of the Death Certificate (DC) to Assess the Cause of Death and Comparison with the Verbal Autopsy: The PRISMA Study

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    Claudio, Muratore; César, Belziti; Darío, Di Toro; José, Gant López; Andrés, Mulassi; Alceo, Barrios; Héctor, Costa; Sebastián, Saravia Toledo.

    2006-06-01

    Full Text Available Los datos del certificado de defunción no reflejan ajustadamente las causas y las circunstancias de la muerte. La comparación con otros métodos de información, como la autopsia verbal, podría demostrar las falencias de los registros. Objetivos 1. Identificar las causas de muerte en 20 ciudades argen [...] tinas mediante la autopsia verbal y compararlas con las que constan en el certificado de defunción. 2. Analizar la muerte cardiovascular en cuanto a antecedentes y factores de riesgo. Material y métodos Se incluyeron todos los mayores de 18 años fallecidos durante 2 meses del año 2004 en las ciudades participantes. Resultados Se constataron 1.274 muertes. Según la autopsia verbal, las causas de muerte cardiovascular más frecuentes fueron insuficiencia cardíaca (23%), accidente cerebrovascular (11,3%) e infarto de miocardio (8%) y las no cardiovasculares fueron neoplasias (21,5%), neumopatías (7,6%) e infecciones (6,6%). En el 11,7% de los fallecidos no se pudo establecer claramente la causa de muerte según el certificado. La concordancia de ambos métodos para definir la causa de muerte según el coeficiente V de Cramer fue de 0,608, el valor de kappa fue de 0,614 (0,580-0,647) y el de kappa ponderado fue de 0,596 (0,555-0,637). Existió un subregistro del 9,7% de insuficiencia cardíaca según el certificado y un sobrerregistro del 6,4% en muerte por otras causas cardiovasculares con respecto a la autopsia verbal. Los fallecidos de causa cardiovascular presentaron con más frecuencia factores de riesgo y antecedentes cardiovasculares. Conclusiones En un porcentaje elevado de certificados de defunción no se pudo establecer claramente la causa de muerte. La mayor discordancia se registró en la muerte por insuficiencia cardíaca y otras causas cardiovasculares. Abstract in english The data contained in the death certificate (DC) do not accurately reflect the causes and circumstances of death. Objectives 1. To identify the cause of death in 20 cities of Argentina using a Verbal Autopsy System (VAS) and compare them to those stated in the DC; 2. To analyze the risk factors and [...] cardiovascular history related to cardiovascular death. Methods We included all subjects older than 18 years of age who died during the 2 month-enrollment period of 2004, in the 20 participant cities. Results A total of 1274 deaths occurred during the period analyzed. According to the VAS, the most frequent causes of cardiovascular death were; heart failure (23%), stroke (11.3%) and myocardial infarction (8%), while the most common noncardiovascular causes of death were: malignancies (21.5%), pneumonia (7.6%) and infections (6.6%). In 11.7 % of deaths, the cause of death could not be clearly established, according to the DC. Agreement for both methods (CD and VAS) in defining the cause of death was 0.608 (V Cramer), kappa value was 0.614 (0.580-0.647) and the kappa weighted value was 0.596 (0.555-0.637). Compared to VAS, the DC underestimated heart failure in 6.6% of cases and overestimated non-cardiovascular deaths in 8% of cases. Cardiovascular death was significantly associated to the presence of risk factors and a history of cardiovascular disease. Conclusions A high proportion of DC's do not clearly establish the cause of death. The greatest discrepancy between the DC and VAS was related to cardiovascular death due to heart failure and other causes of cardiovascular death.

  20. Hallazgos neuropatológicos de la infección por VIH-SIDA: estudio de autopsias en el Hospital Universitario de Santander, Bucaramanga, Colombia / Neuropathologic features of the infection HIV-AIDS: study autopsy in the Hospital Universitario de Santander, Bucaramanga, Colombia

    Scientific Electronic Library Online (English)

    Julio César, Mantilla; Nelson, Cárdenas.

    2009-12-01

    Full Text Available Objetivo: Describir las alteraciones macro y microscópicas observadas en el sistema nervioso central (SNC) de pacientes que fallecieron por la infección con VIH-SIDA. Metodología: Estudio retrospectivo de autopsias del 1 de enero de 2004 al 31 de diciembre de 2007 en un hospital público de tercer ni [...] vel en la ciudad de Bucaramanga, Santander. Resultados: El hallazgo neuropatológico más común en pacientes que fallecieron por la infección VIH-SIDA fue toxoplasmosis cerebral, 17 casos (28.3%) luego criptococosis cerebral, 7 casos (11.6%), tuberculosis del SNC, 3 casos (5%), encefalopatía por HIV, 2 casos (3.3%), meningitis piógena, un caso (1.6%) y hallazgos inespecíficos,2 casos (3.3%). No hubo lesiones neoplásicas, infecciones por citomegalovirus, herpes, histoplasmosis ni leucoencefalopatía multifocal progresiva (LMP) en ninguno de los casos. En el presente estudio se encontraron cambios en el SNC en 32 casos (53.1%), que, después del respiratorio (39-65%), fue el sistema más afectado por las complicaciones relacionadas con la enfermedad por VIH. La presencia de lesión directa (encefalitis por HIV) y al mismo tiempo infección oportunista se encontró sólo en un caso (1.6%). Conclusiones: En Bucaramanga las infecciones oportunistas fueron las complicaciones más frecuentes y graves a nivel del SNC en los enfermos con VIH-SIDA, de ellas la toxoplasmosis cerebral fue la que más comprometió el SNC de los pacientes con infección con VIH-SIDA, y se expresó morfológicamente como una meningoencefalitis necrosante, ubicada de manera preferencial en la región de los ganglios basales. Abstract in english Objective: To describe the macroscopic and microscopic alterations observed in the central nervous system (CNS) in patients who died through HIV-AIDS infection. Method used: Retrospective study of autopsies from January 1st 2004 to December 31st 2007 in a third-level public hospital at Bucaramanga, [...] Santander. Results: The most common neuro-pathological findings in patients who died through HIV-AIDS infection were cerebral toxoplasmosis, 17 cases (28.3%); followed by cerebral cryptococcosis, 7 cases (11.6%); CNS tuberculosis, 3 cases (5%); HIV encephalitis, 2 cases (3.3%); and bacterial meningitis, 1 case (1.6%). Neoplasm lesions, CMV infection, herpes infection, histoplasmosis, and progressive multifocal leucoencephalopathy (PML) were not found in any case. In this study, changes were seen in the CNS in 32 cases (53.1%), which after the respiratory system (39-65%) was the most affected system for complications related to HIV infection. HIV-induced encephalopathy simultaneously with an opportunistic infection was only found in 1 case (1.6 %). Conclusion: In Bucaramanga, opportunistic infections are the most frequent and serious complications in the CNS of individuals with HIV-AIDS; among them cerebral toxoplasmosis was the most frequently observed complication in the CNS of patients with HIV-AIDS, appearing morphologically as a meningoencephalitis with necrosis and large lesions localized in the gangliobasal region.

  1. Retratos de autópsias Psicossociais sobre suicídio de idosos em Teresina / Portraits of Psychosocial autopsies about suicides of elderly people in Teresina / Retratos de autopsias Psicosociales sobre suicidio de ancianos en Teresina

    Scientific Electronic Library Online (English)

    Selena Mesquita Teixeira, Sérvio; Ana Célia Sousa, Cavalcante.

    Full Text Available O desígnio da presente pesquisa consiste em analisar os fatores psicossociais que perpassaram o suicídio de idosos em Teresina, por meio de uma investigação retrospectiva dos aspectos da vida do suicida antes do autoextermínio e da reconstituição dos fatores de risco para o suicídio. Trata-se de uma [...] pesquisa de natureza qualitativa, descritiva e exploratória. Foram construídas autópsias psicossociais de cinco casos de suicídios de idosos ocorridos no período de 2004 a 2009. Esse método reúne três tipos de informação: ficha de identificação pessoal e social, genograma e entrevista semi-estruturada. A coleta foi viabilizada pelo relato de cinco sujeitos, familiares e parentes próximos ao idoso. O material obtido passou por três etapas: pré-análise, análise qualitativa e síntese analítica. Desse modo, os principais fatores de risco associados ao suicídio desses idosos foram: depressão, transtornos mentais graves, estigma referente ao envelhecimento, alcoolismo, automutilações, impulsividade, relações afetivas fragilizadas e história de vida marcada por eventos trágicos. Abstract in spanish El designio de la presente investigación consiste en analizar los factores psicosociales que recorrieron el suicidio de ancianos en Teresina, por medio de una investigación retrospectiva de los aspectos de la vida del suicida antes del auto exterminio y de la reconstitución de los factores de riesgo [...] para el suicidio. Se trata de una investigación de naturaleza cualitativa, descriptiva y exploratoria. Fueron construidas autopsias psicosociales de cinco casos de suicidios de ancianos ocurridos en el período de 2004 a 2009. Ese método reúne tres tipos de información: ficha de identificación personal y social, genograma y entrevista semiestructurada. La recolección fue viabilizada por el relato de cinco sujetos, familiares y parientes próximos al anciano. El material obtenido pasó por tres etapas: pre-análisis, análisis cualitativo y síntesis analítica. De ese modo, los principales factores de riesgo asociados al suicidio de esos ancianos fueron: depresión, trastornos mentales graves, estigma referente al envejecimiento, alcoholismo, automutilaciones, impulsividad, relaciones afectivas fragilizadas e historia de vida marcada por eventos trágicos. Abstract in english The purpose of this research is to examine the psychosocial factors that have permeated the suicide of elderly people in Teresina, through a retrospective investigation of aspects of his/her life before self-extermination and the reconstitution of the risk factors for suicide. This is a qualitative [...] descriptive and exploratory research. Psychosocial autopsies of five cases of elderly suicides that had occurred in the period of 2004-2009 were made. This method combines three types of information: personal identification card, social genogram and semi-structured interview. The collection was made possible by the report of five individuals, family, and relatives who were close to the elderly. The material obtained has undergone three stages: pre-analysis, qualitative analysis and analytical synthesis. Thus, the main risk factors associated with the suicide of these seniors were depression, severe mental illness, stigma related to aging, alcoholism, selfmutilation, impulsivity, fragile affective relationships and life history marked by tragic events.

  2. Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics / Enregistrement par sondage des faits d'état civil ayant donné lieu à une autopsie verbale: nouvelle mobilisation en faveur du recensement et du suivi des statistiques d'état civil / Registro por muestreo de acontecimientos vitales mediante autopsias verbales: un compromiso renovado en la medición y vigilancia de las estadísticas vitales

    Scientific Electronic Library Online (English)

    Philip W., Setel; Osman, Sankoh; Chalapati, Rao; Victoria A., Velkoff; Colin, Mathers; Yang, Gonghuan; Yusuf, Hemed; Prabhat, Jha; Alan D., Lopez.

    2005-08-01

    Full Text Available El registro de los nacimientos, el registro de las defunciones por edad, sexo y causas y el cálculo de los niveles y diferenciales de mortalidad son fundamentales para articular políticas sanitarias basadas en la evidencia y para llevar a cabo el seguimiento y evaluación. No obstante, pocos de los p [...] aíses que más necesidad tienen de esos datos disponen de sistemas operativos para producirlos, aunque la legislación prevea el establecimiento y mantenimiento de sistemas de registro civil. Los sistemas de registro de estadísticas vitales por muestreo (REVM), si se combinan con procedimientos de autopsia verbal validados y aplicados en una muestra de conglomerados de población nacionalmente representativa, representan una solución asequible, costoeficaz y sostenible a corto y medio plazo para ese problema. Los REVM complementan otras fuentes de información generando datos de mortalidad por edad, sexo y causas que son más completos y continuos que los datos actualmente disponibles. Los instrumentos y métodos empleados en los sistemas REVM, sin embargo, son imperfectos y exigen mecanismos rigurosos de validación y una continua garantía de la calidad; también se están perfeccionando todavía las estrategias de muestreo para los REVM. Así y todo, el interés por establecer REVM está aumentando rápidamente enÁfrica y Asia. Unos sistemas mejorados de notificación y registro de los datos sobre acontecimientos vitales sólo serán sostenibles si se desarrollan en estrecha conexión con las estrategias de información sanitaria aplicadas en los niveles nacional y distrital, las estructuras de gobernanza, y las agendas de las investigaciones sociales y la vigilancia del desarrollo. Si la comunidad mundial desea disponer de mediciones de la mortalidad dentro de 5 o 10 años, hay que sentar ya las bases de los sistemas REVM. Abstract in english Registration of births, recording deaths by age, sex and cause, and calculating mortality levels and differentials are fundamental to evidence-based health policy, monitoring and evaluation. Yet few of the countries with the greatest need for these data have functioning systems to produce them despi [...] te legislation providing for the establishment and maintenance of vital registration. Sample vital registration (SVR), when applied in conjunction with validated verbal autopsy procedures and implemented in a nationally representative sample of population clusters represents an affordable, cost-effective, and sustainable short- and medium-term solution to this problem. SVR complements other information sources by producing age-, sex-, and cause-specific mortality data that are more complete and continuous than those currently available. The tools and methods employed in an SVR system, however, are imperfect and require rigorous validation and continuous quality assurance; sampling strategies for SVR are also still evolving. Nonetheless, interest in establishing SVR is rapidly growing in Africa and Asia. Better systems for reporting and recording data on vital events will be sustainable only if developed hand-in-hand with existing health information strategies at the national and district levels; governance structures; and agendas for social research and development monitoring. If the global community wishes to have mortality measurements 5 or 10 years hence, the foundation stones of SVR must be laid today.

  3. Caracterizacion de las Ramas del Arco Aórtico en una Muestra de Poblacion Colombiana: Un Estudio con Material de Autopsia / Characterization of Aortic Arch Branches in a Colombian Population Sample: A Study with Autopsy Material

    Scientific Electronic Library Online (English)

    Néstor Eduardo, Herrera Ortiz; Luis Ernesto, Ballesteros Acuña; Pedro Luis, Forero Porras.

    2012-03-01

    Full Text Available La variabilidad del arco aórtico y sus ramas emergentes presentan implicaciones en los abordajes quirúrgicos de tórax y cuello, y posiblemente en el desarrollo de procesos ateromatosos ubicados a ese nivel y accidentes cerebrovasculares. Se evaluaron 122 arcos aórticos de individuos adultos de ambos [...] sexos obtenidos como material de autopsia. Se identificó la configuración general de la emergencia de las ramas colaterales de los arcos y se determinó la morfometría de sus componentes con medición electrónica. Se observó la presencia de la configuración usual (tipo A) en 87 arcos (71,3%); un tronco braqui-bicarotideo (tipo B) en 21 piezas anatómicas (17,2%) y en 10 casos (8,2%) la arteria vertebral izquierda se originó directamente del arco aórtico (tipo C); en 4 especímenes (3,3%) se presentó emergencia atípica de las ramas. El calibre de la aorta en el punto previo a la emergencia de sus ramas y justo después de emitir su última colateral fue de 20,1mm (DE 3,19) y 17,2mm (DE 2,57) respectivamente, con una disminución del 14,5%. El calibre de las arterias sublavias (7,7mm, DE 1,10) fue significativamente mayor (P=0,0001) que el de las arterias carótidas (6,4mm, DE 0,78). El diámetro de las arterias carótidas derecha e izquierda fue de 6,5mm (DE 0,81) y 6,3mm (DE 0,75) respectivamente. La arteria subclavia derecha presentó mayor calibre que la izquierda (7,9mm, DE 1,09; 7,6mm, DE 1,12) sin diferencia estadisticamente significativa (P=0,0801). La distancia entre el origen del tronco braquiocefálico y el de la subclavia izquierda fue de 32,8mm (DE 6,16) y la longitud del tronco braquiocefálico fue 30,2mm±5,27. Se destaca la alta frecuencia de arcos con emergencia de dos y cuatro ramas. Los calibres de las ramas son menores a lo reportado en la literatura. Abstract in english The variability of the aortic arch and its emergent branches have implications in the surgical approaches of the thorax and neck, and possibly in the development of the atheromatous processes located at that level and the cerebrovascular accidents. We evaluated 122 aortic arches from adult individua [...] ls of both sexes obtained as autopsy material. We identified the general configuration of the emergence of the collateral branches of the arcs and determined the morphometry of its components with electronic measurement. We observed the usual configuration (type A) in 87 arches (71.3%); a brachio-bicarotid trunk (type B) in 21 anatomical specimens (17.2%) and in 10 cases (8.2%) the left vertebral artery originated directly from the aortic arch (type C); 4 specimens (3.3%) presented atypical emergency in the branches. The caliber of the aorta at the point prior to the emergence of its branches and just after casting his last side was 20.1mm (DS 3.19) and 17.2mm (DS 2.57) respectively, with a decrease of 14.5%. The caliber of the subclavian arteries (7.7mm, SD 1.1) was significantly higher (P=0.0001) than of the carotid arteries (64mm, SD 0.78). The diameter of the carotid arteries both right and left were 6.5mm (DS 0.81) and 6.3mm (DS 0.75) respectively. The right subclavian artery presented higher caliber than the left (7.9mm, DS 1.09; 7.6mm, DS 1.12) without significant statistical difference (P=0.0801). The difference between the origin of the brachiocephalic trunk and the left subclavian artery was 32.8 (DS 6.16); the brachiocephalic trunk length was 30.2mm ± 5.27. It highlights the high frequency of arches with emergency of two and four branches. The calibers of the branches are smaller than those reported in the literature.

  4. Caracterizacion de las Ramas del Arco Aórtico en una Muestra de Poblacion Colombiana: Un Estudio con Material de Autopsia Characterization of Aortic Arch Branches in a Colombian Population Sample: A Study with Autopsy Material

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    Néstor Eduardo Herrera Ortiz

    2012-03-01

    Full Text Available La variabilidad del arco aórtico y sus ramas emergentes presentan implicaciones en los abordajes quirúrgicos de tórax y cuello, y posiblemente en el desarrollo de procesos ateromatosos ubicados a ese nivel y accidentes cerebrovasculares. Se evaluaron 122 arcos aórticos de individuos adultos de ambos sexos obtenidos como material de autopsia. Se identificó la configuración general de la emergencia de las ramas colaterales de los arcos y se determinó la morfometría de sus componentes con medición electrónica. Se observó la presencia de la configuración usual (tipo A en 87 arcos (71,3%; un tronco braqui-bicarotideo (tipo B en 21 piezas anatómicas (17,2% y en 10 casos (8,2% la arteria vertebral izquierda se originó directamente del arco aórtico (tipo C; en 4 especímenes (3,3% se presentó emergencia atípica de las ramas. El calibre de la aorta en el punto previo a la emergencia de sus ramas y justo después de emitir su última colateral fue de 20,1mm (DE 3,19 y 17,2mm (DE 2,57 respectivamente, con una disminución del 14,5%. El calibre de las arterias sublavias (7,7mm, DE 1,10 fue significativamente mayor (P=0,0001 que el de las arterias carótidas (6,4mm, DE 0,78. El diámetro de las arterias carótidas derecha e izquierda fue de 6,5mm (DE 0,81 y 6,3mm (DE 0,75 respectivamente. La arteria subclavia derecha presentó mayor calibre que la izquierda (7,9mm, DE 1,09; 7,6mm, DE 1,12 sin diferencia estadisticamente significativa (P=0,0801. La distancia entre el origen del tronco braquiocefálico y el de la subclavia izquierda fue de 32,8mm (DE 6,16 y la longitud del tronco braquiocefálico fue 30,2mm±5,27. Se destaca la alta frecuencia de arcos con emergencia de dos y cuatro ramas. Los calibres de las ramas son menores a lo reportado en la literatura.The variability of the aortic arch and its emergent branches have implications in the surgical approaches of the thorax and neck, and possibly in the development of the atheromatous processes located at that level and the cerebrovascular accidents. We evaluated 122 aortic arches from adult individuals of both sexes obtained as autopsy material. We identified the general configuration of the emergence of the collateral branches of the arcs and determined the morphometry of its components with electronic measurement. We observed the usual configuration (type A in 87 arches (71.3%; a brachio-bicarotid trunk (type B in 21 anatomical specimens (17.2% and in 10 cases (8.2% the left vertebral artery originated directly from the aortic arch (type C; 4 specimens (3.3% presented atypical emergency in the branches. The caliber of the aorta at the point prior to the emergence of its branches and just after casting his last side was 20.1mm (DS 3.19 and 17.2mm (DS 2.57 respectively, with a decrease of 14.5%. The caliber of the subclavian arteries (7.7mm, SD 1.1 was significantly higher (P=0.0001 than of the carotid arteries (64mm, SD 0.78. The diameter of the carotid arteries both right and left were 6.5mm (DS 0.81 and 6.3mm (DS 0.75 respectively. The right subclavian artery presented higher caliber than the left (7.9mm, DS 1.09; 7.6mm, DS 1.12 without significant statistical difference (P=0.0801. The difference between the origin of the brachiocephalic trunk and the left subclavian artery was 32.8 (DS 6.16; the brachiocephalic trunk length was 30.2mm ± 5.27. It highlights the high frequency of arches with emergency of two and four branches. The calibers of the branches are smaller than those reported in the literature.

  5. Utilidad de la determinación de la fracción I de la Troponina cardíaca (cTnI, en el diagnóstico de la muerte súbita de origen cardíaco en autopsias forenses Usefulness of cardiac troponin I (cTnI in the diagnosis of sudden cardiac death in forensic autopsies

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    E. Navarro

    2007-07-01

    Full Text Available Objetives: To evaluate practical usefulness of cardiac Troponin analysis (cTnI in peripheral blood levels, in order to improve diagnosis of sudden cardiac death in routine forensic cases. Comparing these levels with Myoglobin and MB-CK blood levels in the same type of samples. Material and methods: We have studied 97 medico legal autopsies performed in the Pathology Service of the Institute of Legal Medicine (Alicante. In every case we analyzed sample of serum from peripheral blood (femoral, by Microparticle Enzyme Immunoassay (MEIA Axsym system (Abbott Diagnostics. Causes of death were classified into 6 groups according: 1 Death of cardiac origin (n=42; 2 Traumatic deaths (n=19; 3 Death by asphyxia (n=12; 4 Natural deaths of non-cardiac origin (n=8; 5 Miscellaneous group (n=6, and 6 Traumatic death with Thoracic trauma (n=10. Data was analysed by means of SPSS 14.0 statistical software program (SPSS Inc, 2005. Results: cTnI levels were significantly high in cases of sudden cardiac death, but it were also high in the group of thoracic trauma, which could raise diagnosis problems between these groups, as was shown previously in the literature. Conclusions: The determination of cTnI is more efficient than CKMB and Myoglobine in the diagnosis of sudden cardiac death. However, the elevation of mean levels of this marker in cases of severe thoracic traumatism limits its diagnostic usefulness in these situations.

  6. Utilidad de la determinación de la fracción I de la Troponina cardíaca (cTnI), en el diagnóstico de la muerte súbita de origen cardíaco en autopsias forenses / Usefulness of cardiac troponin I (cTnI) in the diagnosis of sudden cardiac death in forensic autopsies

    Scientific Electronic Library Online (English)

    E., Navarro; R., Bañón; S., Giner; MA., Devesa; B., Cardona.

    2007-07-01

    Full Text Available [...] Abstract in english Objetives: To evaluate practical usefulness of cardiac Troponin analysis (cTnI) in peripheral blood levels, in order to improve diagnosis of sudden cardiac death in routine forensic cases. Comparing these levels with Myoglobin and MB-CK blood levels in the same type of samples. Material and methods: [...] We have studied 97 medico legal autopsies performed in the Pathology Service of the Institute of Legal Medicine (Alicante). In every case we analyzed sample of serum from peripheral blood (femoral), by Microparticle Enzyme Immunoassay (MEIA) Axsym system (Abbott Diagnostics). Causes of death were classified into 6 groups according: 1) Death of cardiac origin (n=42); 2) Traumatic deaths (n=19); 3) Death by asphyxia (n=12); 4) Natural deaths of non-cardiac origin (n=8); 5) Miscellaneous group (n=6), and 6) Traumatic death with Thoracic trauma (n=10). Data was analysed by means of SPSS 14.0 statistical software program (SPSS Inc, 2005). Results: cTnI levels were significantly high in cases of sudden cardiac death, but it were also high in the group of thoracic trauma, which could raise diagnosis problems between these groups, as was shown previously in the literature. Conclusions: The determination of cTnI is more efficient than CKMB and Myoglobine in the diagnosis of sudden cardiac death. However, the elevation of mean levels of this marker in cases of severe thoracic traumatism limits its diagnostic usefulness in these situations.

  7. Muerte inesperada súbita en el Servicio de Urgencias, de paciente tratada por neurosis de ansiedad, portadora de un feocromocitoma descubierto durante la autopsia. Sudden unexpected death at the medical Emergency Service of a patient, treated for anxiety neurosis, who had a heochromocytoma, found at forensic autopsy.

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    A. Serratosa

    2002-07-01

    Full Text Available Los pacientes que sufren problemas psiquiátricos graves, y aquellos otros cuya sintomatología se encuentra a caballo entre los trastornos emocionales puros y los dependientes de la somatización de los conflictos psíquicos constituyen un colectivo de enfermos que necesitan de especial atención y esfuerzo diagnóstico. Los primeros conforman un grupo de alto riesgo de muerte inesperada por enfermedades, tan comunes, que realmente sorprende que no fuesen diagnosticadas y tratadas a tiempo. Los segundos se enfrentan a la dificultad diagnóstica de diferenciar entre lo verdaderamente emocional y lo somático, con el peligro secundario de obviar la verdadera causa somática de algunos cuadros clínicos con sintomatología fácilmente etiquetada de psíquica. A veces la realidad se impone de manera drástica, y legalmente conflictiva para el médico o el equipo de asistencia hospitalaria. Presentamos un caso de muerte inesperada, que tuvo lugar en el Servicio de Urgencias, de una paciente diagnosticada de neurosis de ansiedad. La Autopsia Médico-Legal descubrió la existencia de un feocromocitoma de la médula suprarrenal izquierda.Patients who suffer serious psychiatric problems, and those others whose symptoms are half way between purely emotional disorders and those dependent on somatization of psychological conflicts, make up a group of patients for whom diagnosis requires special attention and effort. The first form a group at high risk of unexpected death from illnesses so common that it is really surprising that they are not diagnosed and treated in time. The second are faced with the difficulty at diagnosis of differentiating between the truly emotional and the somatic, with the secondary danger of obviating the real somatic cause of some clinical state, with symptoms easily labelled as psychological. At times reality asserts itself drastically, and is legally conflictive for the doctor or the hospital team. We present a case of unexpected death, which took place at the Medical Emergency Service, of a patient diagnosed with anxiety neurosis. The forensic autopsy discovered the existence of a pheochromocytoma of the left suprarenal medulla.

  8. Prevalência e padrão de distribuição das doenças cerebrovasculares em 242 idosos, procedentes de um hospital geral, necropsiados em Belo Horizonte, Minas Gerais, no período de 1976 a 1997 Prevalence and types of cerebrovascular diseases in 242 hospitalized elderly patients, autopsied in Belo Horizonte, Minas Gerais, Brazil, from 1976 to 1997

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    José Eymard H. Pittella

    2002-03-01

    Full Text Available OBJETIVO: Descrever a prevalência e os tipos das doenças cerebrovasculares (DCVs em indivíduos idosos necropsiados. MÉTODO: Foram consultados os laudos neuropatológicos de 242 pacientes com idade igual ou superior a 61 anos, procedentes em sua maioria do Hospital das Clínicas da Universidade Federal de Minas Gerais, em Belo Horizonte, Minas Gerais, e necropsiados consecutivamente no período 1976 a 1997. RESULTADO: Os principais grupos de doenças do sistema nervoso central (SNC foram representados por DCVs (71,9%, infecções (12,4%, neoplasias (7,1%, traumatismos crânio-encefálicos (3,7%, doenças nutricionais (2,5% e doenças degenerativas (1,7%. As DCVs mais frequentes foram: aterosclerose (61,2%, doença cerebrovascular hipertensiva (25,6% e infarto cerebral (14,9%. Observou-se aumento da frequência e da gravidade da aterosclerose e da frequência da doença cerebrovascular hipertensiva com o avançar da idade. Houve associação significativa entre doença cerebrovascular hipertensiva e aterosclerose. As DCVs foram clinicamente sintomáticas e as responsáveis diretas pelo óbito em 42,7% e 17,3% dos pacientes, respectivamente. CONCLUSÃO: As DCVs constituíram o principal grupo de doenças do SNC no idoso. A aterosclerose e a doença cerebrovascular hipertensiva foram as principais doenças deste grupo, notando-se aumento de sua frequência com o avançar da idade e associação significativa entre ambas.OBJECTIVE: To describe the prevalence and the types of cerebrovascular diseases (CVDs in autopsied elderly individuals. METHOD: Consecutive clinical charts and neuropathological reports of 242 patients aged 61 years or older were reviewed. The patients died in Hospital das Clínicas, Federal University of Minas Gerais, in Belo Horizonte, Minas Gerais, Brazil, from 1976 to 1997. RESULTS: The prevalent diseases of the central nervous system (CNS found in decreasing order were: CVDs (71.9%, infections (12.4%, neoplasms (7.1%, head trauma (3.7%, nutritional diseases (2.5% and degenerative diseases (1.7%. The most common CVDs were cerebral atherosclerosis (61.2%, hypertensive cerebrovascular disease (25.6% and cerebral infarct (14.9%. There was an increase in prevalence and severity of atherosclerosis and an increase in prevalence of hypertensive cerebrovascular disease with advancing age. A significant association between hypertensive cerebrovascular disease and atherosclerosis was found. The CVDs patients had clinical stroke and this was the direct cause of death in 42,7% and 17,3% of the cases, respectively. CONCLUSION: The CVDs were the most prevalent group of diseases of the CNS in elderly patients. Atherosclerosis and hypertensive cerebrovascular disease were the most common CVDs, and its prevalence increased with advancing age. Hypertensive cerebrovascular disease was significantly associated with atherosclerosis.

  9. Factores causales del daño múltiple de órganos en 11 307 autopsias realizadas en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto" / Causal factors of multiple organ damage in 11 307 autopsies performed in "Dr. Luis Díaz Soto" Higher Institute of Military Medicine

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    Teresita, Montero González; José, Hurtado de Mendoza Amat; Magaly, Iglesias Duquesne; Verónica, Walwyn Salas; María Ofelia, Cabrejas Acuña; Isela, Pérez Bomboust.

    2008-03-01

    Full Text Available El daño múltiple de órganos es un conjunto de trastornos morfológicos frecuentes en pacientes críticos, asociado con diversos factores causales donde primordialmente ocurre un daño inmunológico que se concatena con un daño sistémico, y que de acuerdo con su intensidad puede evolucionar hacia la muer [...] te inmediata, regresar o manifestarse evolutivamente con un síndrome de daño múltiple de órganos. Se realizó este trabajo con el propósito de identificar el comportamiento y la relación de los factores causales del daño múltiple de órganos en las autopsias de adultos del Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto". Se estudiaron retrospectivamente 13 910 fallecidos entre el año 1962 y 2004, de ellos 11 307 mayores de 16 años de edad según la base de datos SARCAP, divididos en grupos de estudios en relación con los factores causales. Para el diagnóstico se consideró la presencia del factor causal, 3 o más órganos afectados; se excluyeron estos cuando presentaban lesiones previas relacionadas con el daño múltiple de órganos, y se valoró la sepsis, solo la severa. El trabajo muestra cómo el daño múltiple de órganos se relaciona con los factores causales que lo desencadenan y se analiza que evitar la acción de los factores causales contribuiría a prolongar la vida de los pacientes si se aplican medidas terapéuticas que atenúen la respuesta inflamatoria sistémica y el daño múltiple de órganos, por lo que su prevención salva vidas. Abstract in english The multiple organ damage is a set of frequent morphological disorders in critical patients, associated with causal factors, where it mainly occurs an immunological damage that concatenates with a systemic damage and that according to its intensity it may evolve towards immediate death, recurs or ma [...] nifest with a syndrome of multiple organ damage. This paper was aimed at identifying the behavior and the relation of the causal factors of the multiple organ damage in the autopsies of adults performed in "Dr. Luis Díaz Soto" Higher Institute of Military Medicine. 13 910 deceased were retrospectively studied between 1962 and 2004, of them 11 307 were over 16 according to the SARCAP database. They were divided into study groups according to the causal factors. For the diagnosis, it was considered the presence of causal factors, 3 or more affected organs that were excluded when they presented previous lesions related to multiple organ damage, and only severe sepsis was assessed. It was proved how the multiple organ damage was related to the causal factors triggering them, and it was also concluded that avoiding the action of the causal factors would contribute to prolong the patients' life if therapeutical measures attenuating the systemic inflammatory response and the multiple organ damage were taken, since their prevention may save lives.

  10. Factores causales del daño múltiple de órganos en 11 307 autopsias realizadas en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto" Causal factors of multiple organ damage in 11 307 autopsies performed in "Dr. Luis Díaz Soto" Higher Institute of Military Medicine

    Directory of Open Access Journals (Sweden)

    Teresita Montero González

    2008-03-01

    Full Text Available El daño múltiple de órganos es un conjunto de trastornos morfológicos frecuentes en pacientes críticos, asociado con diversos factores causales donde primordialmente ocurre un daño inmunológico que se concatena con un daño sistémico, y que de acuerdo con su intensidad puede evolucionar hacia la muerte inmediata, regresar o manifestarse evolutivamente con un síndrome de daño múltiple de órganos. Se realizó este trabajo con el propósito de identificar el comportamiento y la relación de los factores causales del daño múltiple de órganos en las autopsias de adultos del Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto". Se estudiaron retrospectivamente 13 910 fallecidos entre el año 1962 y 2004, de ellos 11 307 mayores de 16 años de edad según la base de datos SARCAP, divididos en grupos de estudios en relación con los factores causales. Para el diagnóstico se consideró la presencia del factor causal, 3 o más órganos afectados; se excluyeron estos cuando presentaban lesiones previas relacionadas con el daño múltiple de órganos, y se valoró la sepsis, solo la severa. El trabajo muestra cómo el daño múltiple de órganos se relaciona con los factores causales que lo desencadenan y se analiza que evitar la acción de los factores causales contribuiría a prolongar la vida de los pacientes si se aplican medidas terapéuticas que atenúen la respuesta inflamatoria sistémica y el daño múltiple de órganos, por lo que su prevención salva vidas.The multiple organ damage is a set of frequent morphological disorders in critical patients, associated with causal factors, where it mainly occurs an immunological damage that concatenates with a systemic damage and that according to its intensity it may evolve towards immediate death, recurs or manifest with a syndrome of multiple organ damage. This paper was aimed at identifying the behavior and the relation of the causal factors of the multiple organ damage in the autopsies of adults performed in "Dr. Luis Díaz Soto" Higher Institute of Military Medicine. 13 910 deceased were retrospectively studied between 1962 and 2004, of them 11 307 were over 16 according to the SARCAP database. They were divided into study groups according to the causal factors. For the diagnosis, it was considered the presence of causal factors, 3 or more affected organs that were excluded when they presented previous lesions related to multiple organ damage, and only severe sepsis was assessed. It was proved how the multiple organ damage was related to the causal factors triggering them, and it was also concluded that avoiding the action of the causal factors would contribute to prolong the patients' life if therapeutical measures attenuating the systemic inflammatory response and the multiple organ damage were taken, since their prevention may save lives.

  11. Surveillance of abused drugs in forensic autopsy cases in Norway

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    Svetlana V. Konstantinova-Larsen

    2011-12-01

    Full Text Available High drug related mortality has been registered in Norway. Although comparison between countries relies on a standard international coding system of diseases, different practices in verifying cause of death and applying codes could lead to variation. The comparison gives no information on drug findings or drug patterns underlying the cause of deaths. To evaluate deaths involving illicit drugs in Norway, we examined drug patterns in 2735 forensically examined post-mortem samples collected from 15-64 year-old individuals from 2000 to 2009. There were four times as many men as women among the deceased illicit drug users, and the majority were in the age group 25-44 years. The number of deceased showing signs of illicit drug use has gradually declined during the study period. The decline was found among younger individuals, while a larger proportion of the deceased were above 45 years of age in 2009, compared to 2000. Cases positive for heroin, ethanol, ecstasy and flunitrazepam were fewer in 2009, while the prevalence of amphetamine, cannabis, methadone and other opioids has increased. The prevalence of methamphetamine has increased ten fold, and the prevalence of benzodiazepines doubled. Thus, the drug pattern and age of the deceased has changed markedly during the last 10 years. Heroin and ethanol use has partly been substituted by use of amphetamines, cannabis, benzodiazepines and other opioids. This change could possibly be explained by the prolonged survival of drug users on substitution treatment and by the reduced toxicity of consumed drugs.

  12. An autopsy case of pulmonary fissure induced by zygomycosis

    OpenAIRE

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

    2013-01-01

    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 Universit...

  13. Histo-morphology of age of contusions: An autopsy study

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    A K Unmesh

    2012-06-01

    Full Text Available Background