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Sample records for autopsy

  1. [Clinical autopsy evaluation].

    PubMed

    Sakugawa, H; Saito, A

    1999-01-01

    The hospital autopsy rate in Japan dropped from 63.5 per cent in 1972 to 20.9 per cent in 1995. This reduction is attributable to declining interest by clinicians, surgeons and pathologists. The decline is a very serious problem, because the autopsy contributes to what has been called "quality control" of medical care. However, the method of autopsy should change along with advances in diagnostic technology or various changes in the circumstances surrounding medical practice. The most important problem at present is that autopsies require both time and effort. Delayed autopsy reports by pathologists may result in declined interest by clinicians and thus limit the benefits. To shorten the time delay for autopsy reports, clinicians must clarify their clinical questions concerning the deceased patient so that pathologists can readily identify the patients' problems and determine the causes more promptly, clearly and diplomatically. Other suggestions for improvement include the following: the reports should be simpler; the concept that all autopsies must be complete should be eliminated; a hospital accreditor must emphasize that clinicians intend to gain more precise diagnoses by obtaining post-mortem tissues of various organs using biopsy instruments. In addition, communication between pathologists and clinicians must be active to determine the pathogenesis of disease. PMID:10067363

  2. Assessing the autopsy.

    PubMed Central

    Nemetz, P. N.; Ludwig, J.; Kurland, L. T.

    1987-01-01

    This study outlines the role of autopsies in medical practice and health policy, details the nature and reason for declining rates, including those in Rochester, Minnesota, and suggests possible remedial measures to halt or reverse this trend. It is concluded that one of the principal impediments to reversing the declining rate of autopsies is what is referred to in Economics as "market failure." In particular, the nature of the spatial and temporal distribution of costs and benefits has precluded the existence of an incentive structure which can lead to a realization of the major net social benefits from the autopsy. Ultimately, it is only the explicit recognition by the medical profession, government agencies, corporate insurers, and the general public of the nature and significance of this market failure and foregone benefits which can lead to remediation. PMID:3113257

  3. Napoleon's autopsy: new perspectives.

    PubMed

    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

  4. 38 CFR 17.170 - Autopsies.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Autopsies. 17.170 Section 17.170 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Autopsies § 17.170 Autopsies. (a) Except as provided in this section, no autopsy will be performed by the Department of Veterans Affairs unless there is no...

  5. Requesting perinatal autopsy: multicultural considerations.

    PubMed

    Chichester, Melanie

    2007-01-01

    The subject of perinatal autopsy is not frequently seen in the literature. Perinatal loss, particularly stillbirth, frequently remains unexplained, despite current technology and diagnostic procedures. Parents may automatically refuse an autopsy, despite the potentially valuable information it could provide about the current pregnancy and subsequent pregnancies and despite the possible comfort the results could provide for relatives. Other reasons for declining an autopsy could be cultural or religious prohibitions. In addition, healthcare providers sometimes lack the knowledge of circumstances under which a postmortem examination is permitted, and fail to use culturally sensitive and culturally competent discussions about the reasons a postmortem examination is important and permissible. This purpose of this article is to provide information on selected cultural and religious groups to assist the nurse who is seeking consent for a perinatal autopsy. PMID:17356412

  6. Hospital autopsy performance and reporting.

    PubMed

    Benjamin, Jacqueline

    2014-01-01

    Postmortem examinations have been performed for centuries (King and Meehan, Am J Pathol 73(2): 514-541, 1973; Burton, The history of the autopsy. Hodder Arnold, Hachette UK, London, pp 1-10, 2010) and have a long and venerable tradition, one which is sadly on the decline worldwide (Underwood, The future of the autopsy. Hodder Arnold, Hachette UK, London, pp 11-17, 2010; Nemetz et al., Mayo Clin Proc 64:1065-2076, 1989; Kaplan, Hum Pathol 9(2):127-129, 1978; Roberts, N Engl J Med 299:332-337, 1978; Haber, Arch Pathol Lab Med 120:714-717, 1996; AMA Council on Scientific Affairs, Arch Pathol Lab Med 120:721-726, 1996; Sanner, Arch Pathol Lab Med 118:878-883, 1994; Robinson, Hum Pathol 14(7):566-568, 1983). One of the reasons cited for the decline in postmortem examinations is new imaging techniques such as computerized tomography and magnetic resonance imaging. The advent of these new diagnostic procedures has not resulted in obsolescence of the relatively low-cost, high-yield autopsy examination (Goldman et al., N Engl J Med 308:1000-1005, 1983). The procedure for performance of an autopsy, using the Zenker method (Volmar, History of autopsy technique. College of American Pathologists, Northfield, IL, pp 18-19, 2003), is described, in addition to the content and format of the written report. PMID:25015147

  7. Hospital autopsy: Endangered or extinct?

    PubMed Central

    Turnbull, Angus; Osborn, Michael; Nicholas, Nick

    2015-01-01

    Aim To determine the hospital autopsy rate for the UK in 2013. Methods A study of data from a ‘Freedom of Information’ request to all (n=186) acute NHS Trusts within England (n=160), NHS Boards in Scotland (n=14) and Wales (n=7) and Social Care Trusts in Northern Ireland (n=5). Hospital autopsy rates were calculated from the number of hospital autopsies performed in 2013 as a percentage of total inpatient deaths in the Trust that year. Results The UK response rate was 99% (n=184), yielding a mean autopsy rate of 0.69%. The mean rates were 0.51% (England), 2.13% (Scotland), 0.65% (Wales) and 0.46% (Northern Ireland). 23% (n=38) of all included respondents had a rate of 0% and 86% (n=143) a rate less than 1%. Conclusions The decline in hospital autopsy has continued relentlessly and, for better or for worse, the practice is on the verge of extinction in the UK. The study highlights to health professionals and policy makers the magnitude of this decline. Further research should investigate the impact of this on patient safety, clinical audit, public health and medical education. PMID:26076965

  8. Traumatic asphyxia: An autopsy case.

    PubMed

    Türkmen, Nursel; Eren, Bülent; Erkol, Zerrin

    2015-01-01

    Traumatic asphyxia is a form of asphyxia where respiration is prevented by external pressure on the body. A 19-year-old man was found by relatives compressed by motorboat in the garage. The death was investigated by the prosecutor; body was taken to the Morgue Department for performing autopsy. On gross physical examination; the face, neck and upper part of the chest were congested and many petechiae were observed on the conjunctivae, but not in low extremities. Autopsy macroscopic examination of lungs revealed congestion, sub pleural superficial bleeding areas. In the presented case death was reported as traumatic asphyxia by thorax compression without other lethal factors. PMID:26585308

  9. The Autopsy of Squirrel Doe

    ERIC Educational Resources Information Center

    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…

  10. 20 CFR 718.106 - Autopsy; biopsy.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Autopsy; biopsy. 718.106 Section 718.106... PNEUMOCONIOSIS Criteria for the Development of Medical Evidence § 718.106 Autopsy; biopsy. (a) A report of an autopsy or biopsy submitted in connection with a claim shall include a detailed gross macroscopic...

  11. Autopsy training programs. To right a wrong.

    PubMed

    Hasson, J; Schneiderman, H

    1995-03-01

    Autopsy rates have decreased from a peak of 41.1% in 1964 to less than 5% in many hospitals today. This disaster has stimulated many symposia and articles on the values of the autopsy, the reasons for its fall, and possible remedies. The many benefits of the autopsy include quality assessment of clinical diagnoses; added knowledge about new diseases, environmental hazards, and genetic disorders; and evaluation of new technologies. The autopsy is also a powerful educational tool. The main reasons for its decline include fear of medical litigation and professional discreditation due to unexpected findings, the unsubstantiated notion that technologic advances have rendered the autopsy obsolete, cost-cutting pressures, and inadequate compensation for pathologists. This essay addresses a remedy for another major contributing problem: clinicians' frustration at poorly performed autopsies due to defective training of autopsy pathologists. Requirements for excellent autopsy training programs include an intensive review of anatomy applied to dissection methods, including sequences of dissection; direct supervision of early cases by a competent and responsible senior pathologist at the autopsy table, with full responsibility assigned to the trainee only after completion of this apprenticeship; review of all cases with clinical staff at regularly scheduled gross organ conferences; and a sustained commitment by department heads to make necessary programmatic changes to meet these standards. Pathologists must demonstrate pursuit of excellence in performance of the autopsy before other ambitious elements are sought for its revival. PMID:7887788

  12. [Cervical fractures in autopsy records].

    PubMed

    Pankowski, Rafał; Wilmanowska, Anita; Gos, Tomasz; Smoczyński, Andrzej

    2003-01-01

    We reviewed the autopsy records of 1872 cases of death because of politrauma, gunshot wounds and suicidal hanging. The analysis included causes and frequency of cervical spine fractures, their most common localisation, architecture of bone destruction and their influence on cervical cord. The most common cause of cervical spine injury was motor vehicle accidents. We examined 82 specimens with traumatic fractures of cervical spine obtained from accident victims. About half of the injuries occurred in upper cervical spine. The most common fracture localisation was C2 with dens fracture as the most frequent injury. The most common spinal cord lesion was complete rupture mainly at the upper cervical spine level. PMID:14564791

  13. Low perinatal autopsy rate in Malaysia: time for a change.

    PubMed

    Tan, Geok Chin; Hayati, Abdul Rahman; Khong, Teck Yee

    2010-01-01

    Our objectives were to determine the perinatal autopsy rate in a tertiary hospital in Malaysia and to quantify the value of the perinatal autopsy. All stillbirths, miscarriages, therapeutic abortions, and neonatal deaths between January 1, 2004, and August 31, 2009, were identified from the archives. The autopsy findings were compared with the clinical diagnoses. The autopsy reports were also reviewed to determine if it would be possible to improve the quality of the autopsies. There were 807 perinatal deaths, of which 36 (4.5%) included an autopsy. There were ethnic differences in the rate of autopsy, with the lowest rate among the Malays. The autopsy provided the diagnosis, changed the clinical diagnosis, or revealed additional findings in 58.3% of cases. Ancillary testing, such as microbiology, chromosomal analysis, and biochemistry, could improve the quality of the autopsy. This study provides further data on the perinatal autopsy rate from an emerging and developing country. It reaffirms the value of the perinatal autopsy. Attempts must be made to improve on the low autopsy rate while recognizing that the performance of autopsies can be enhanced through the use of ancillary testing. PMID:20367214

  14. Autopsy pathology storage and coding by microcomputer.

    PubMed

    Talamo, T S; Losos, F J; Kessler, G F

    1982-02-01

    Storage and coding of anatomic pathology data usually is accomplished by expensive main frame systems. The authors of this article have developed a microcomputer based program package for autopsy pathology which stores patient demographic data, provisional or final anatomic diagnoses, and coded diagnoses obtained from an on-line Systematized Nomenclature of Pathology (SNOP) code lexicon. The system includes limited text editor functions as well as rapid data retrieval with the generation of final reports. Data files containing SNOP codes and diagnoses are searched easily by a variety of parameters, making data retrieval of autopsy material simple and efficient. PMID:10254292

  15. 42 CFR 37.202 - Payment for autopsy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Payment for autopsy. 37.202 Section 37.202 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF UNDERGROUND COAL MINERS Autopsies § 37.202 Payment for autopsy....

  16. 42 CFR 37.202 - Payment for autopsy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Payment for autopsy. 37.202 Section 37.202 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF UNDERGROUND COAL MINERS Autopsies § 37.202 Payment for autopsy....

  17. 42 CFR 37.202 - Payment for autopsy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Payment for autopsy. 37.202 Section 37.202 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF UNDERGROUND COAL MINERS Autopsies § 37.202 Payment for autopsy....

  18. 42 CFR 37.202 - Payment for autopsy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Payment for autopsy. 37.202 Section 37.202 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF UNDERGROUND COAL MINERS Autopsies § 37.202 Payment for autopsy....

  19. 42 CFR 37.202 - Payment for autopsy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Payment for autopsy. 37.202 Section 37.202 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF COAL MINERS Autopsies § 37.202 Payment for autopsy. (a) The...

  20. 28 CFR 549.80 - Authority to conduct autopsies.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Authority to conduct autopsies. 549.80 Section 549.80 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Authority To Conduct Autopsies § 549.80 Authority to conduct autopsies. (a) The...

  1. Emotionally challenging learning situations: medical students' experiences of autopsies

    PubMed Central

    Scheja, Max; Hult, Håkan; Wernerson, Annika

    2012-01-01

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

  2. Adult Hirschsprung's disease diagnosed during forensic autopsy.

    PubMed

    Chatelain, Denis; Manaouil, Cécile; Marc, Bernard; Ricard, Jannick; Brevet, Marie; Montpellier, Dominique; Defouilloy, Christian; Jardé, Olivier

    2006-09-01

    We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences. PMID:17018101

  3. Turquoise to dark green organs at autopsy.

    PubMed

    Warth, Arne; Goeppert, Benjamin; Bopp, Christian; Schirmacher, Peter; Flechtenmacher, Christa; Burhenne, Jürgen

    2009-03-01

    We report the case of a 72-year-old man who died in septic shock following pancreatectomy. At autopsy, organs were discoloured with a rapid colour change from turquoise to dark green, especially of the myocardium. The patient had received 200 mg methylene blue (MB), i.v., for treatment of septic shock 90 min prior to death. Analysis of tissue samples by liquid extraction and liquid chromatography coupled to tandem mass spectrometry demonstrated different concentrations of MB and its metabolites azure A and B in the heart, lungs, kidneys, and liver. Our findings clearly demonstrate the relation of MB administration and organ discolouration at autopsy and shed a new light on MB distribution and accumulation in septic shock. PMID:19189125

  4. [Digital autopsy archive using the personal computer].

    PubMed

    Maier, R D; Althoff, H

    1990-01-01

    The development of a dissection register for Legal medicine well differentiated and considering special requirement of the subject was not achieved in history because of complexity of post mortem findings in many cases. Realizing that an all satisfying concept failed we looked for the possibility of using electronic data processing for rapid and flourish collection of autopsy results not requiring much time for the coroner. Based on personal computer software "dBase" a database program was developed easy to handle using different forms asking for characteristic circumstances of the case and essential post mortem findings. Short codes for locations and ascertainments were chosen to enable rapid selection of interesting statements as far as handling for statistical evaluations later on. Less then 10 minutes are needed for recording post mortem results in this way short time after autopsy. PMID:2220128

  5. Correlation between ultrasound diagnosis and autopsy findings of fetal malformations

    PubMed Central

    Vimercati, Antonella; Grasso, Silvana; Abruzzese, Marinella; Chincoli, Annarosa; de Gennaro, Alessandra; Miccolis, Angela; Serio, Gabriella; Selvaggi, Luigi; Fascilla, Fabiana Divina

    2012-01-01

    Summary Objective to compare ultrasound (US) and autopsy findings of fetal malformations in second trimester terminations of pregnancy to evaluate the degree of agreement between US and fetal autopsy. Methods in this study, all second trimester termination of pregnancy between 2003–2010 were considered. US and autopsy findings were compared and all cases were classified into five categories according to the degree of agreement between US and pathology (A1: full agreement between US and autopsy; A2: autopsy confirmed all US findings but revealed additional anomalies ‘rarely detectable’ prenatally; B: autopsy demonstrated all US findings but revealed additional anomalies ‘detectable’ prenatally; C: US findings were only partially demonstrated at fetal autopsy; D: total disagreement between US and autopsy). Results 144 cases were selected. In 49% of cases there was total agreement between US and autopsy diagnosis (A1). In 22% of cases additional information were about anomalies ‘not detectable’ by US (A2). In 12% of cases autopsy provided additional information about anomalies not observed but ‘detectable’ by US (B). In 13% of cases some anomalies revealed at US, such as valve insufficiencies, pericardial and pleural effusions, were not verified at autopsy (C). Total lack of agreement was noted only in 4% of cases (D). Main areas of disagreement concerned cardiovascular, CNS and complex malformations. The degree of agreement was higher if malformations were diagnosed in a tertiary center. Conclusions this study shows an overall high degree of agreement between definitive US and autopsy findings in second trimester termination of pregnancy for fetal malformations. Autopsy reveals to be the best tool to diagnose malformations and often showed other abnormalities of clinical importance not detected by US, but sometimes also US could provide additional information about functional anomalies because US is a dynamic examination. PMID:22905306

  6. The autopsy crisis reexamined: the case for a national autopsy policy.

    PubMed

    Hill, R B; Anderson, R E

    1991-01-01

    The use of autopsy in medical practice in the United States has declined drastically over the past 25 years. Physicians conduct post-mortem examinations on less than 12 percent of persons who die in hospitals and on proportionally far fewer people who die at home. Without due assessment of causes of death, pathologists lose opportunities to conduct critical diagnostic exercises, and society fails to obtain accurate health statistics. Medical practitioners, legislators, insurers, and the public should consider diverse features of a national policy for assuring that sufficient numbers of autopsies are competently performed and their findings appropriately employed. PMID:2034185

  7. A pathologist׳s perspective on the perinatal autopsy.

    PubMed

    Ernst, Linda M

    2015-02-01

    The perinatal autopsy is an important tool in the investigation of fetal and neonatal death, and a complete understanding of its risks and benefits is necessary for providers of perinatal care. This review, from the perspective of a perinatal pathologist, reports the details of the autopsy procedure, its goals, its value to individual patients and the health care system in general, and its alternatives. Even with new emerging technologies, the conventional perinatal autopsy remains the gold standard for determining the cause of death and the final summary of all pathologic findings. Therefore, the information provided in this review can help providers properly convey information about perinatal autopsy to bereaved families. PMID:25511296

  8. Application of the verbal autopsy during a clinical trial.

    PubMed

    Pacqué-Margolis, S; Pacqué, M; Dukuly, Z; Boateng, J; Taylor, H R

    1990-01-01

    During a community-based treatment trial of onchocerciasis with ivermectin, verbal autopsies were employed as one method to assess the safety of the drug. The verbal autopsy questionnaire was designed to determine causes of death and mortality differentials in the treated population. During the 8 months of surveillance here reported, 25 individuals died, yet only 9 of these deaths were certified. Seven of the deaths occurred to individuals who had been treated with ivermectin and the majority of the deaths occurred to children under 5, who were excluded from treatment. The verbal autopsy method was evaluated and validated by comparing the verbal autopsy diagnosis of cause of death to death certificate diagnosis, when available. In addition, verbal autopsies were retrospectively performed for all deaths which had occurred at the hospital during the 6 months preceding the start of the study, if these deaths were traceable to households in the surveillance population. We found that in 80% of the adult deaths, the verbal autopsy and death certificate diagnoses of underlying cause of death agreed. The verbal autopsy was less accurate in diagnosing child deaths which we attribute to the design of the verbal autopsy (being to detect potential drug related deaths in adults) and to the delay between death and interview. We conclude that verbal autopsies are an important addition to surveillance systems in remote areas where the absence or inadequacy of health information systems does not allow a thorough follow-up of all subjects in drug studies. PMID:2218641

  9. Profile of medicolegal autopsies in Pekanbaru, Indonesia 2007-2011.

    PubMed

    Afandi, Dedi

    2012-12-01

    Medicolegal autopsy should be carried out for all unnatural deaths to ascertain facts pertaining to death. A retrospective 5-year study was carried out by the Forensic Medicine and Medicolegal Department, Faculty of Medicine, University of Riau to describe the profile of medicolegal autopsies in Pekanbaru, Indonesia. There were 613 unnatural deaths and 73 (11.9%) medicolegal autopsies recorded between 2007 and 2011. The number of unnatural deaths showed a decreasing trend whereas the number of medicolegal autopsies increased over the years. The percentage of unnatural deaths subjected to medicolegal autopsy varied between 2.2% and 23.1% per year. Of the 73 medicolegal autopsy subjects, 68.5% (n = 50) were male and 31.5% (n = 23) females. The ages of victims ranged from newborn babies to 72 years, with a median of 28 years. 61.6% of cases were in the 20-39 years age-group. Sixty (82.2%) had unnatural deaths. The leading cause of death was blunt force (30.1%) and sharp force (20.5%). Homicide was the predominant manner of death. Our study highlights that the main interest of the police in requesting a medicolegal autopsy is for investigation of homicide. Recognizing that autopsy has an important role in the investigation of unnatural deaths, further studies should be carried out to understand the factors that impact on the low percentage of medicolegal autopsies in unnatural deaths, so that solutions may be found for the future. PMID:23424774

  10. Management and autopsy of a radioactive cadaver.

    PubMed

    Wallace, A B; Bush, V

    1991-06-01

    A 69 year old male was treated with an ablative dose of 3.7 GBq (100 mCi) of I131 for carcinoma of the thyroid and died 10 days after administration. The requirement for an autopsy and the level of radiation still present in the body necessitated the intervention of Radiation Safety Personnel to minimise support staff radiation exposure and area contamination. Preventative measures were taken in accordance with the ALARA principle and a detailed procedure is presented as a suggested model for any future occurrence. PMID:1747080

  11. Fetal autopsy and closing the gap.

    PubMed

    Kandasamy, Yogavijayan; Kilcullen, Meegan; Watson, David

    2016-06-01

    Over the past 30 years, the perinatal mortality rate (PMR) in Australia has been reduced to almost a quarter of that observed in the 1970s. To a large extent, this decline in the PMR has been driven by a reduction in neonatal mortality. Stillbirth rates have, however, remained relatively unchanged, and stillbirth rates for Aboriginal or Torres Strait Islander mothers have remained approximately twice that for non-Indigenous women over the last 10 years. The causes for this difference remain to be fully established. Fetal autopsy is the single most important investigative tool to determine the cause of fetal demise. While facilitators and barriers to gaining consent for autopsy have been identified in a non-Indigenous context, these are yet to be established for Indigenous families. In order to address the gap in stillbirths between Indigenous and non-Indigenous mothers, it is essential to identify culturally appropriate ways when approaching Aboriginal and Torres Strait Islander families for consent after fetal death. Culturally safe and appropriate counselling at this time provides the basis for respectful care to families while offering an opportunity to gain knowledge to reduce the PMR. Identifying the cause of preventable stillbirth is an important step in narrowing the disparity in stillbirth rates between Indigenous and non-Indigenous mothers. PMID:27250705

  12. An autopsy case of zinc chloride poisoning.

    PubMed

    Kondo, Takeshi; Takahashi, Motonori; Watanabe, Seiya; Ebina, Masatomo; Mizu, Daisuke; Ariyoshi, Koichi; Asano, Migiwa; Nagasaki, Yasushi; Ueno, Yasuhiro

    2016-07-01

    Ingestion of large amounts of zinc chloride causes corrosive gastroenteritis with vomiting, abdominal pain, and diarrhea. Some individuals experience shock after ingesting large amounts of zinc chloride, resulting in fatality. Here, we present the results of an administrative autopsy performed on a 70-year-old man who ingested zinc chloride solution and died. After drinking the solution, he developed vomiting, abdominal pain, and diarrhea, and called for an ambulance. Except for tachycardia, his vital signs were stable at presentation. However, he developed hypotension and severe metabolic acidosis and died. The patient's blood zinc concentration on arrival was high at 3030μg/dL. Liver cirrhosis with cloudy yellow ascites was observed, however, there were no clear findings of gastrointestinal perforation. The gastric mucosa was gray-brown, with sclerosis present in all gastric wall layers. Zinc staining was strongly positive in all layers. There was almost no postmortem degeneration of the gastric mucosal epithelium, and hypercontracture of the smooth muscle layer was observed. Measurement of the zinc concentration in the organs revealed the highest concentration in the gastric mucosa, followed by the pancreas and spleen. Clinically, corrosive gastroenteritis was the cause of death. However, although autopsy revealed solidification in the esophagus and gastric mucosa, there were no findings in the small or large intestine. Therefore, metabolic acidosis resulting from organ damage was the direct cause of death. PMID:27497327

  13. Verbal autopsy: current practices and challenges.

    PubMed Central

    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 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

  14. An Autopsy Checklist: A Monitor of Safety and Risk Management.

    PubMed

    Shkrum, Michael James; Kent, Jessica

    2016-09-01

    Any autopsy has safety and risk management issues, which can arise in the preautopsy, autopsy, and postautopsy phases. The London Health Sciences Department of Pathology and Laboratory Medicine Autopsy Checklist was developed to address these issues. The current study assessed 1 measure of autopsy safety: the effectiveness of the checklist in documenting pathologists' communication of the actual or potential risk of blood-borne infections to support staff. Autopsy checklists for cases done in 2012 and 2013 were reviewed. The frequency of communication, as recorded in checklists, by pathologists to staff of previously diagnosed blood-borne infections (hepatitis B/C and human immunodeficiency virus) or the risk of infection based on lifestyle (eg, intravenous drug abuse) was tabulated. These data were compared with medical histories of the deceased and circumstances of their deaths described in the final autopsy reports. Information about blood-borne infections was recorded less frequently in the checklists compared with the final reports. Of 4 known human immunodeficiency virus cases, there was no checklist documentation in 3. All 11 hand injuries were documented. None of these cases had known infectious risks. The Autopsy Checklist is a standardized means of documenting safety and risk issues arising during the autopsy process, but its effectiveness relies on accurate completion. PMID:27356015

  15. The Penetrating Gaze and the Decline of the Autopsy.

    PubMed

    Stempsey, William E

    2016-01-01

    Understanding the decline in the autopsy rate can be furthered through analysis of Foucault's idea of the medical gaze and the ancient Greek idea of theoria. The medical gaze has shifted over time from the surface of the body to the inner organs to the cellular and subcellular levels. Physicians and loved ones of the deceased person are not likely to "gaze" at the same levels. Patients' loved ones might not theorize as physicians do; they have different interests, which suggest the need for more attention to informed consent for autopsies. Responding to this need should take priority over efforts to increase the autopsy rate, and it can also be seen as an opportunity to improve autopsy and autopsy consent practices. PMID:27550568

  16. Autopsy issues in German Federal Republic transplantation legislation until 1997.

    PubMed

    Schweikardt, Christoph

    2014-01-01

    This article analyzes the relevance of autopsy issues for German Federal Republic transplantation legislation until 1997 against the background of legal traditions and the distribution of constitutional legislative powers. It is based on Federal Ministry of Justice records and German Parliament documents on transplantation legislation. Transplantation and autopsy legislation started with close ties in the 1970s. Viewing transplantation legislation as relevant for future autopsy regulation contributed to the decision to stall transplantation legislation, because the interests of the federal government and the medical profession converged to avoid subsequent restrictions on the practice of conducting autopsies and procuring tissues for transplantation. Sublegal norms were insufficient for the prosecution of the organ trade and area-wide transplantation regulation after the reunification of Germany. In contrast to autopsy issues, legislative power for transplantation issues was extended to the federal level by an amendment to the constitution, allowing decision making for Germany as a whole. PMID:25557516

  17. Where have all the autopsies gone? A proposal for a centralized autopsy service.

    PubMed

    Mitchell, E K; Prior, J T

    1995-10-01

    A litany of reasons have been advanced to account for the decrease in hospital autopsy rates. Increased attention has recently been centered on the difficulty hospital and medical examiner morgues are encountering in controlling infectious disease and attempting to comply with federal and state environmental regulatory agencies. The problem has been highlighted by autopsy examinations upon increased numbers of immuno-compromised patients harboring both the HIV and secondary drug resistant tuberculosis organisms. These developments occur at a time when there are budgetary restraints on hospitals and medical examiners' offices facing large expenditures involving morgue reconstruction to comply with ventilatory and infection control procedures mandated by state and federal agencies. Challenging, also, are the liability aspects, as patients and staff are potentially exposed to a variety of infectious agents. A possible solution is presented involving central off-hospital site facilities to which hospital autopsies can be funneled. A community morgue meeting the strict standards of infection control would allow economy of scale from daily use with a full time support staff trained in the protocol of infectious disease control. PMID:8550871

  18. Colchicine-Induced Rhabdomyolysis: An Autopsy Case.

    PubMed

    Arslan, Murat Nihat; Özgün, Ayşe; Daş, Taner; Kumru, Durmuş; Şam, Bülent; Koç, Sermet

    2016-06-01

    Colchicine is derived from Colchicum autumnale and Gloriosa superba and is used to treat acute gout and familial Mediterranean fever (FMF). Musculoskeletal adverse effects range from myopathy to rhabdomyolysis. An 18-year-old woman, with a 2-year history of FMF treated with colchicine, took 9 colchicine pills (4.5 mg) to relieve severe abdominal pain. On the sixth day of hospitalization, the patient's condition worsened, and she died. As this was a case of fatal poisoning, a forensic autopsy was performed, and the cause of death was determined to be complications of muscle destruction due to colchicine intoxication with the findings of myocytolysis, positive antimyoglobin antibody staining kidney tubules. Colchicine toxicity begins with gastrointestinal symptoms. Multiorgan effects follow the gastrointestinal effects. Serious outcomes of colchicine toxicity are rhabdomyolysis, bone marrow suppression, and disseminated intravascular coagulation. In chronic diseases that require lifelong treatment with medications, adverse effects can arise with long periods of use. Our patient had been treated for FMF with colchicine for 2 years but took too many colchicine pills to relieve her severe abdominal pain. Warning patients about the effects of high doses of drugs and providing information about their toxic effects and what to do "in case" of overuse could be lifesaving. PMID:27049658

  19. [An autopsy case of neonatal lactic acidosis].

    PubMed

    Giordano, G; Corradi, D; D'Adda, T; Melissari, M

    2001-02-01

    Defects in mitochondrial enzymes, such as pyruvate dehydrogenase and cytochrome oxidase, cause hereditary disorders which lead to modifications in cellular pH due to the accumulation of pyruvate and lactic acid. Mitochondrial diseases include severe neonatal diseases and less severe forms of adult diseases. We report the case of lactic acidosis in a newborn girl who was delivered at 36 weeks of gestation and who died 3 months after birth. Her family history revealed a relative with tetraparesis and mental retardation. Her clinical findings, such as tonic-clonic convulsions and accumulation of pyruvate and lactic acid in blood, urine and cerebrospinal fluid, were refractory to treatment and developed soon after birth. Ultrasound scans of the brain some days before death revealed cerebral atrophy with ventricular dilatation and thinning of the corpus callosum and septum pellucidum. The clinical diagnosis of metabolic lactic acidosis was confirmed by macroscopic, microscopic and ultrastructural findings seen at autopsy. On macroscopic examination, the heart was hypertrophic, and the brain was atrophic with ventricular dilatation and thinning of corpus callosum. Small cystic lesions were present in the basal ganglia. On microscopic examination, the latter were characterized by loss of neurons, gliosis and capillary proliferation. Ultrastructural examination of the heart and skeletal muscle showed lysis of myofibrils, mitochondrial pleomorphism and hyperplasia, and crystalline inclusion in mitochondria and in the matrix compartment. In reporting this case, we emphasize the importance of accurate postmortem examination and clinical data for the diagnosis of metabolic lactic acidosis. PMID:11294018

  20. The Molecular Autopsy: Should the Evaluation Continue After the Funeral?

    PubMed Central

    Tester, David J.; Ackerman, Michael J.

    2012-01-01

    Sudden cardiac death (SCD) is one of the most common causes of death in developed countries, with most SCDs involving the elderly, and structural heart disease evident at autopsy. Each year, however, thousands of sudden deaths involving individuals younger than 35 years of age remain unexplained after a comprehensive medicolegal investigation that includes an autopsy. In fact, several epidemiologic studies have estimated that at least 3% and up to 53% of sudden deaths involving previously healthy children, adolescents, and young adults show no morphologic abnormalities identifiable at autopsy. Cardiac channelopathies associated with structurally normal hearts such as long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome (BrS) yield no evidence to be found at autopsy, leaving coroners, medical examiners, and forensic pathologists only to speculate that a lethal arrhythmia might lie at the heart of a sudden unexplained death (SUD). In cases of autopsy-negative SUD, continued investigation through either a cardiologic and genetic evaluation of first- or second-degree relatives or a molecular autopsy may elucidate the underlying mechanism contributing to the sudden death and allow for identification of living family members with the pathogenic substrate that renders them vulnerable, with an increased risk for cardiac events including syncope, cardiac arrest, and sudden death. PMID:22307399

  1. Neuropathology of supercentenarians - four autopsy case studies.

    PubMed

    Takao, Masaki; Hirose, Nobuyoshi; Arai, Yasumichi; Mihara, Ban; Mimura, Masaru

    2016-01-01

    Supercentenarians (aged 110 years old or more) are extremely rare in the world population (the number of living supercentenarians is estimated as 47 in the world), and details about their neuropathological information are limited. Based on previous studies, centenarians (aged 100-109 years old) exhibit several types of neuropathological changes, such as Alzheimer's disease and Lewy body disease pathology, primary age-related tauopathy, TDP-43 pathology, and hippocampal sclerosis. In the present study, we provide results from neuropathological analyses of four supercentenarian autopsy cases using conventional and immunohistochemical analysis for neurodegenerative disorders. In particular, we focused on the pathology of Alzheimer's disease and Lewy body disease, as well as the status of hippocampal sclerosis, TDP-43 pathology, aging-related tau astrogliopathy, and cerebrovascular diseases. Three cases were characterized as an "intermediate" level of Alzheimer's disease changes (NIA-AA guideline) and one was characterized as primary age-related tauopathy. TDP-43 deposits were present in the hippocampus in two cases. Neither Lewy body pathology nor hippocampal sclerosis was observed. Aging-related tau astrogliopathy was consistently observed, particularly in the basal forebrain. Small vessel diseases were also present, but they were relatively mild for cerebral amyloid-beta angiopathy and arteriolosclerosis. Although our study involved a small number of cases, the results provide a better understanding about human longevity. Neuropathological alterations associated with aging were mild to moderate in the supercentenarian brain, suggesting that these individuals might have some neuroprotective factors against aging. Future prospective studies and extensive molecular analyses are needed to determine the mechanisms of human longevity. PMID:27590044

  2. [Adult autopsies in a French university hospital (CHU Amiens) for the period 1975-2005].

    PubMed

    Chatelain, Denis; Brevet, Marie; Guernou, Malika; Manaouil, Cécile; Leclercq, Fabienne; Bruniau, Alexis; Cordonnier, Carole; Sevestre, Henri

    2007-09-01

    We have reviewed the pathological reports of adult necropsies performed in Amiens hospital during the 1975-2005 period. 1,639 autopsies were performed in 1,049 men and 590 women. We distinguished three periods: 1975-1987 (period 1) with a high number of autopsies (86/year), 1988-1996 (period 2) with a huge decrease of autopsies performed (43/year) and 1997-2005 (period 3) with few autopsies performed (14/year). Patients were younger during period 3, 38% were less than 50 years old versus 26% and 29% during periods 1 and 2. The sex ratio M/F increased during period 3 (2.7 versus 1.7 and 1.9 during periods 1 and 2). Period 3 showed an increase of major diagnoses discovered during autopsies (36% versus 28% of autopsies performed during periods 1 and 2) and showed an increase of autopsies performed after iatrogenic events (20% versus 12% and 13% of autopsies of periods 1 and 2). Period 3 showed an increase of the delay between the death of patients and autopsy and a decrease of the delay of transmission of pathological reports. 2% of autopsies were never answered by the pathologists. In conclusion, our study confirms the major decline of autopsies during the last 30 years. Patients autopsied are currently young men and the autopsies are more frequently performed in potential forensic circumstances. Selection biases explain that major diagnoses are more frequently found at autopsies nowadays than 30 years ago. PMID:18185448

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

    PubMed

    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

  4. An audit of autopsy rates in an inner London general hospital.

    PubMed Central

    Lazda, E J; Brown, D C

    1994-01-01

    Low autopsy rates are of continuing concern to pathologists. The aim of this study was to investigate the reasons why autopsy did not happen, and to determine whether carrying out the investigation and providing some feedback of the results would have any effect on autopsy rates. The main reasons why autopsy did not happen were that junior doctors considered it unnecessary because the diagnosis and cause of death appeared to be well established, and that patients' relatives declined to give permission for autopsy. No increase in autopsy rates was demonstrated, but possible avenues of approach were suggested and these are being implemented. PMID:7837184

  5. Autopsy Practice in Ghana - Reflections of a Pathologist.

    PubMed

    Anim, J T

    2015-06-01

    Autopsy practice in Ghana can be said to be far from satisfactory. Most Ghanaians do not know that there are different categories of death, which categories of death require an autopsy and who is required to perform the autopsy. The problems have further been complicated by the fact that, unlike other countries where separate facilities are available for storage of the different categories of dead bodies, all dead bodies in Ghana are conveyed to the hospital mortuary, thus encouraging hospitals to expand body storage facilities in their mortuaries to meet the increasing demand. Public or community mortuaries used elsewhere for storage of bodies of deaths occurring in the community pending the Coroner's directions are non-existent in Ghana. Storage of all categories of dead bodies in hospital mortuaries has resulted in virtually all autopsies being done by the hospital pathologists, especially in the large centres, at the expense of other very important diagnostic functions of the pathologist. This paper explains relevant portions of the Coroner's Act of 1960 and emphasises the need to separate the few hospital autopsies that require the expertise of the pathologist from Coroner's autopsies that may be carried out by any registered medical officer, as specified in the Act, or better still, by specially trained Forensic Physicians/Medical Examiners, as pertains in other countries. The paper also clarifies the different categories of death, those that fall in the jurisdiction of the Coroner and the personnel required to assist the Coroner in his investigastions. Suggestions have also been made on how to approach manpower development to ensure that appropriate personnel are trained to assist the Coroner in the investgation of medico-legal cases. PMID:26339096

  6. Autopsy-Proven Intravascular Lymphoma Presenting as Rapidly Recurrent Strokes

    PubMed Central

    Usuda, Daisuke; Arahata, Masahisa; Temaru, Rie; Iinuma, Yoshitsugu; Kanda, Tsugiyasu; Hayashi, Shinichi

    2016-01-01

    We present a 79-year-old Japanese woman diagnosed with cerebral infarction. In spite of enough antiplatelet and anticoagulant therapy, she presented rapidly recurrent strokes three times for 3 months. Magnetic resonance imaging showed progression of bilateral cerebral infarcts, and chest-abdominal computed tomography showed multiple bilateral nodular lesions in the lung and multiple tumor lesions in the liver. Autopsy revealed diagnosis of intravascular lymphoma (IVL). This case indicates that IVL is rare and usually goes undiagnosed until time of autopsy because of its protean neurological manifestations; hence, it should be considered as a possible etiology if multiple strokes occur in a short period of time. PMID:27065845

  7. Psychological Autopsy Studies as Diagnostic Tools: Are They Methodologically Flawed?

    ERIC Educational Resources Information Center

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

    2012-01-01

    One of the most established "truths" in suicidology is that almost all (90% or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the…

  8. Psychological Autopsy Provides Insight into Gifted Adolescent Suicide.

    ERIC Educational Resources Information Center

    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,…

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

    PubMed

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

    2013-06-10

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

  10. The Psychological Autopsy as a Tool in Student Affairs.

    ERIC Educational Resources Information Center

    Grieger, Ingrid; Greene, Paul

    1998-01-01

    Discusses psychological autopsies as a way of preventing suicide on college campuses. A review team develops a narrative of events leading up to incident, reviews actions taken within the campus emergency process, gathers information about the student, makes recommendations for prevention activities, and provides debriefing for those responsible…

  11. Fatal ammonia inhalation. A case report with autopsy findings.

    PubMed

    Price, S K; Hughes, J E; Morrison, S C; Potgieter, P D

    1983-12-01

    A 25-year-old refrigeration technician died 85 days after accidental massive anhydrous ammonia inhalation; the case history and autopsy findings are described. The latter included bronchiectasis and obliterative bronchiolitis, but interstitial fibrosis and emphysema were conspicuously absent. The roles of dosage, infection, and healing are discussed. PMID:6648731

  12. [Examination results and autopsy findings in assaults on elderly people].

    PubMed

    Bode-Jänisch, Stefanie; Havermann, Robert; Germerott, Tanja; Fieguth, Armin

    2010-01-01

    As the percentage of elderly people in the population grows, violence against persons of advanced age constitutes an increasing social problem. The findings of the clinical forensic examinations (CE group) and autopsies performed on elderly violence victims (> or = 60 years) between 1999 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In all, the study material comprised 55 victims of the CE group (35 females and 20 males, median age 73.5 years) and 55 autopsies (33 females and 22 males, median age 72.7 years). In most of the autopsy cases, the suspect was a family member or partner. In contrast, the alleged perpetrator was a stranger in most cases of the CE group. Blunt force injuries were most often found in the CE group victims (63.6%). Altogether, 38.2% (CE group) and 20.0% (autopsy cases) of the violent assaults were associated with robbery. In the majority of the CE cases, the victims suffered potentially or acute life-threatening injuries. In summary, the analysis shows that elderly people frequently become victims of robbery and blunt force injury. In most homicides of old people, the perpetrator is familiar to the victim. In surviving elderly violence victims, the assault is more likely to be reported to the police if the suspect is a stranger. PMID:21254704

  13. 28 CFR 549.80 - Authority to conduct autopsies.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... inmate of the facility in the event of homicide, suicide, fatal illness or accident, or unexplained death... level of Acting Warden. (2) When the conducting of an autopsy requires permission of the family or next-of-kin, the following message is to be included in the telegram notifying the family or...

  14. An Institutional Autopsy of St. Augustine Junior College

    ERIC Educational Resources Information Center

    Lumadue, Richard T.

    2009-01-01

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

  15. The American Theological Seminary: An Unfamiliar Institutional Autopsy

    ERIC Educational Resources Information Center

    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…

  16. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Autopsies and other post-mortem operations. 35.16 Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.16 Autopsies and other post-mortem operations. Autopsies, or other...

  17. An Attempt to Motivate Internal Medicine Housestaff to Obtain Consent for Autopsies.

    ERIC Educational Resources Information Center

    Sidorov, Jaan

    1990-01-01

    A study found that a 50-minute lecture on the value of autopsy had little effect on housestaff patterns of requesting autopsies. Housestaff (n=27) attending the lecture did not request more autopsies or obtain more permissions than did the control group (n=26). Results suggest more sophisticated techniques than lectures should be used. (Author/MSE)

  18. [A Forensic Autopsy Case Applied for Asbestos-Related Disease].

    PubMed

    Makihara, Kosuke; Hamada, Tetsuo; Kasai, Kentaro; Tanaka, Toshiko; Sato, Hiroaki

    2016-03-01

    We had a forensic autopsy case that required additive pathological examination for the asbestos-related lung disease compensatory application afterwards. A man in his sixties with a history of occupational asbestos inhalation who had neither visited a hospital nor received a physical examination received forensic autopsy because of his death from unknown cause. An inmate said, "He developed cough and dyspnea, and died in the progression of the symptoms." The autopsy revealed widespread pleural plaques on both sides of the parietal pleura and multiple tumors in both sides of the lungs. The cause of death was diagnosed as lung cancer. Additional pathological examination was asked by his family to certify that he had suffered from asbestos-related lung disease in order to apply to the Asbestos-related Damage Relief Law. The Japanese criteria of the compensation law of asbestos-related lung cancer is the detection of more than 5,000 asbestos bodies per gram of dry lung tissue, while his number of asbestos bodies was 4,860. Asbestos bodies were reported to be accumulated in the distal lung parenchyma with no pathological changes. The present lung samples were collected from proximal section around the tumor, which might have made the number of asbestos bodies less than the criteria. Both the number of patients suffering from asbestos-related lung disease and the number of forensic autopsy cases have increased in Japan. Collecting lung samples from the appropriate lung section is essential and should be noted when the lung cancer is suspected at forensic autopsy in order to apply for asbestos-related lung disease compensation. PMID:26972947

  19. An osteological revisitation of autopsies: comparing anthropological findings on exhumed skeletons to their respective autopsy reports in seven cases.

    PubMed

    Cappella, A; Castoldi, E; Sforza, C; Cattaneo, C

    2014-11-01

    Forensic anthropologists and pathologists are more and more requested to answer questions on bone trauma. However limitations still exist concerning the proper interpretation of bone fractures and bone lesions in general. Access to known skeletal populations which derive from cadavers (victims of violent deaths) who underwent autopsy and whose autopsy reports are available are obvious sources of information on what happens to bone trauma when subjected to taphonomic variables, such as burial, decomposition, postmortem chemical and mechanical insults; such skeletal collections are still however quite rare. This study presents the results of the comparative analysis between the autopsy findings on seven cadavers (six of which victims of blunt, sharp or gunshot wounds) and those of the anthropological assessment performed 20 years later on the exhumed dry bones (part of the Milano skeletal collection). The investigation allowed us to verify how perimortem sharp, blunt and gunshot lesions appear after a long inhumation period, whether they are still recognizable, and how many lesions are no longer detectable or were not detectable at all compared to the autopsy report. It also underlines the importance of creating skeletal collections with known information on cause of death and trauma. PMID:25315679

  20. The medical autopsy as quality assurance tool in clinical medicine: dreams and realities.

    PubMed

    van den Tweel, Jan G; Wittekind, Christian

    2016-01-01

    The purpose of medical autopsy has changed to issues of quality assurance today. In addition, autopsies are considered valuable in medical education, e.g., delivering cases for problem-based learning for students. Many studies underscore the need for autopsies also in the era of technical progress emphasizing the continuing discrepancies between antemortem and post mortem diagnoses. Despite these important tasks, we face a decline of autopsy for several reasons with complex interactions. The role of all persons involved in this decline is evaluated and suggestions for changes are proposed. Last but not least, the future of the autopsy is in the hands of pathology itself. PMID:26316183

  1. [Applications and advantages of a multimedia system for autopsies ].

    PubMed

    Gualco, M; Benzi, D; Fulcheri, E

    2001-10-01

    This work evaluates the benefits and applications of computers and multimedia systems in post-mortem examination practice and, more in particular, in the definition of data collection protocols. We examined issues concerning the different aims of autopsy (e.g. diagnostic, scientific, educational, legal), and found that the pathologist's main duty is to acquire a large amount of data in the best possible way. However, despite the will to carry out detailed post-mortem examinations, many pathologic anatomy services face objective difficulties in doing so, especially due to understaffing, lack of time and high costs. The Institute for Pathologic Anatomy of the University of Genoa has developed software for data handling and for outcome reporting, a particularly important aspect in fetal-perinatal diagnosis. The system consists of a relational database in a client-server environment (Fourth Dimension) with two integrated parts. The first part, with unrestricted access, contains patients' personal data, including gender, age, time and date of death, hospital department of origin, person and department requiring the post-mortem examination, hour and time of autopsy, pathologist's name, and clinical diagnosis of death. Using a scanner, a copy of the autopsy application is also field, together with the patient's medical file and any diagnostic images useful to document the case history. The second part of the information system is accessible by pathologists only, and contains the autopsy report. This part is organized to balance two different needs: it allows sufficient space and freedom for autopsy description while providing guidelines for presentation of the report. The structure of the conventional autopsy protocol has been maintained, with subdivisions for all the organs and apparatuses according to topographic criteria. Before this part, a section is dedicated to external cadaver examination and anthropometric data; weight, shape, volume and texture are described for

  2. The Homicide-Suicide Phenomenon: Findings of Psychological Autopsies.

    PubMed

    Knoll, James L; Hatters-Friedman, Susan

    2015-09-01

    Homicide-suicide represents a single episode of violence which may decimate an entire family. This study aimed to further describe motives and context of these tragedies. Psychological autopsies were completed for 18 homicide-suicide cases in Dallas, Texas. This included postevent interviews with surviving family members and review of police and coroner records. Two-thirds of perpetrators had made either verbal or written threats prior to the homicide-suicide. A simplified typology describing victim-perpetrator relationship and motive type is suggested for future studies and clinical ease. Two-thirds of perpetrators fell into the category of Intimate-Possessive, most of whom were depressed men who were abusing substances and undergoing separation. Additional categories included Intimate-Ailing, Filial-Revenge, Familial-Psychotic, and Friend-Psychotic. Further, implications from this psychological autopsy study regarding risk assessment include use of collateral interviews regarding threats and past violence. PMID:26259152

  3. Enlarged parietal foramina: a rare forensic autopsy finding.

    PubMed

    Durão, Carlos; Carpinteiro, Dina; Pedrosa, Frederico; Machado, Marcos P; Cunha, Eugénia

    2016-05-01

    Enlarged parietal foramina (EPF) are a quite rare developmental defect of the parietal bone which has to be distinguished from the normal small parietal foramina. We report a forensic case of an individual found in an advanced state of putrefaction in his own house with an undetermined cause of death. No evidence of trauma was observed, and the toxicological exam was negative. The victim was a 40-year-old man with a history of epilepsy. The large biparietal foramina, a rare anatomical variation and unusual autopsy finding, were observed at autopsy. The recognition of anatomical variations is important to avoid false interpretations and conclusions and has a significant potential as an identity factor, thus contributing to positive identification. PMID:26233611

  4. Histomorphology of renal dysplasia--an autopsy study.

    PubMed

    Kakkar, Nandita; Menon, Santosh; Radotra, B D

    2006-01-01

    A retrospective analysis of pediatric autopsies in the past 18 years was done with the aim of studying the histomorphology of renal dysplasia. Renal dysplasia comprised 150 (3.66%) of the 4,099 pediatric autopsies from 20 weeks of gestation to 1 year of life. Primitive ducts with the fibromuscular collar, the sine qua non of renal dysplasia, was seen in all cases. Lobar disorganization and cysts were seen in all cases except for the 7 cases of hypodysplasia. Other elements were seen in varying proportions: cartilage in 33.7%, bone in 1.08%, thickening of basement membrane of the primitive ducts in 64.13%, extramedullary hematopoiesis in 98.9%, nerve twigs in 72.8%, and nodular renal blastema in 2.17% cases. In unilateral multicystic dysplasia/renal agenesis, the contralateral kidney showed abnormalities in 44.45% and 47.37% of cases, respectively. PMID:16908457

  5. A case of occult intrahepatic cholangiocarcinoma diagnosed by autopsy.

    PubMed

    Oda, Eri; Hashimoto, Daisuke; Shiomi, Yuko; Ohnishi, Koji; Hayashi, Hiromitsu; Chikamoto, Akira; Takeya, Motohiro; Baba, Hideo

    2015-12-01

    Cancer of unknown primary is associated with unknown biology and dismal prognosis. The most common primary sites of cancer of unknown primary were usually the lungs in autopsy studies, and intrahepatic cholangiocarcinoma is rare. We describe the case of a 57-year-old male patient with systemic lymph node metastasis. Imaging examination failed to reveal primary cancer; however, immunostaining of cytokeratins 7, 19, and 20 of a metastatic axillary lymph node suggested a pancreaticobiliary cancer as a primary lesion. He died of liver abscess and sepsis, and then, autopsy indicated occult intrahepatic cholangiocarcinoma. We discuss the clinical course of this rare cholangiocarcinoma including the diagnostic procedure and also present a review of the English literature regarding patients with cancer of unknown primary. PMID:26943425

  6. Respiratory outcomes among South African coal miners at autopsy

    SciTech Connect

    Naidoo, R.N.; Robins, T.G.; Murray, J.

    2005-09-01

    Studies of dose-response relationships between respiratory outcomes at autopsy and coal dust exposure are limited. The Pathology Automation System (PATHAUT) database of South African miners, is one of the largest autopsy databases of occupational lung disease. This study described the prevalence of respiratory outcomes among South African coal miners at autopsy, and determined whether dose response relationships existed between emphysema and exposure. Autopsies conducted from 1975 to 1997 on coal miners with exclusive coal mining exposure and having exposure duration information (n = 3,167) were analyzed from PATHAUT Logistic regression was used to determine relationships between exposure and outcomes, controlling for race, smoking and age on a subset for whom smoking history was available (n = 725). The prevalence of silicosis, tuberculosis (TB), coal workers' pneumoconiosis (CWP), and moderate and marked emphysema were 10.7%, 5.2%, 7.3%, and 64%, respectively. All diseases, except TB, were associated with exposure duration. Black miners had 8.3 and 1.2 fold greater risks for TB and CWP, respectively, than white miners. White miners had an increased risk of 1.4 and 5.4 for silicosis and moderate to marked emphysema, respectively. In models unadjusted for age, and including smoking, moderate to marked emphysema was strongly associated with exposure duration (OR = 3.4; 95% CI = 1.9-5.9 for highest tercile of exposure duration). Exposure-related risk estimates were reduced when age was introduced into the model. However age and duration of exposure were highly correlated, = 0. 68) suggesting a dilution of the exposure effect by age. There were significant dose related associations of disease, including emphysema, with coal dust exposure.

  7. The Abbreviated Injury Scale: application to autopsy data.

    PubMed

    Adams, V I; Carrubba, C

    1998-09-01

    Twenty autopsy reports, comprising 1 fall, 1 cutting, 1 burn, 1 drowning, 1 strangulation, 3 gunshot wound, and 13 traffic fatalities, were scored by the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). The codes were adequate for wounds of skin and long bones, and for most wounds of viscera. The autopsy descriptions were more detailed than the coding criteria for craniocerebral, cervicovertebral and muscular trauma, and less detailed for thoracoabdominal visceral, and long bone trauma. Lung contusions and rib fractures received scores that seemed unduly high, possibly reflecting the greater sensitivity of autopsy diagnosis over clinical diagnosis for these lesions. Complete hinge fractures of the skull base scored 4 (severe), which does not reflect the almost universally lethal nature of the accompanying cerebral concussion, which was itself not codeable. AIS scores were low and did not seem to reflect the lethal outcome when the lethal mechanism was purely physiologic and without a striking morphologic derangement, as in instances of cerebral or cardiac concussion, compression of the neck, occlusive airway hemorrhage, and visceral herniation into an adjacent body cavity. The scores were similarly low when therapy was delayed or adverse. Low AIS and ISS scores in a fatality from blunt or penetrating trauma may be useful retrospective clues to the presence of purely physiologic death mechanisms or therapeutic problems. PMID:9760090

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

    PubMed

    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

  9. Imaging and virtual autopsy: looking back and forward

    PubMed Central

    Bolliger, Stephan A.; Thali, Michael J.

    2015-01-01

    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

  10. Antemortem MRI findings associated with microinfarcts at autopsy

    PubMed Central

    Raman, Mekala R.; Preboske, Gregory M.; Przybelski, Scott A.; Gunter, Jeffrey L.; Senjem, Matthew L.; Vemuri, Prashanthi; Murphy, Matthew C.; Murray, Melissa E.; Boeve, Bradley F.; Knopman, David S.; Petersen, Ronald C.; Parisi, Joseph E.; Dickson, Dennis W.; Jack, Clifford R.

    2014-01-01

    Objective: To determine antemortem MRI findings associated with microinfarcts at autopsy. Methods: Patients with microinfarcts (n = 22) and patients without microinfarcts (n = 44) who underwent antemortem MRI were identified from a dementia clinic–based, population–based, and community clinic–based autopsy cohort. The microinfarct and no-microinfarct groups were matched on age at MRI, age at death, sex, APOE status, Mini-Mental State Examination score, and pathologic diagnosis of Alzheimer disease. Brain infarcts were assessed on fluid-attenuated inversion recovery (FLAIR) MRI. White matter hyperintensities on FLAIR MRI and hippocampal volumes on T1-weighted MRI were quantified using automated methods. A subset of subjects with microinfarcts (n = 15) and a matched group of subjects without microinfarcts (n = 15) had serial T1-weighted MRIs and were included in an analysis of global and regional brain atrophy rates using automated methods. Results: The presence of cortical (p = 0.03) and subcortical (p = 0.02) infarcts on antemortem MRI was associated with presence of microinfarcts at autopsy. Higher numbers of cortical (p = 0.05) and subcortical (p = 0.03) infarcts on antemortem MRI were also associated with presence of microinfarcts. Presence of microinfarcts was not associated with white matter hyperintensities and cross-sectional hippocampal volume on antemortem MRI. Whole-brain and regional precuneus, motor, and somatosensory atrophy rates were higher in subjects with microinfarcts compared to subjects without microinfarcts. Conclusions: Microinfarcts increase brain atrophy rates independent of Alzheimer disease pathology. Association between microinfarct pathology and macroinfarcts on MRI suggests either common risk factors or a shared pathophysiology and potentially common preventive targets. PMID:24793188

  11. The lumbar interspinous bursae and Baastrup's syndrome. An autopsy study.

    PubMed

    Bywaters, E G; Evans, S

    1982-01-01

    This study describes the prevalence, distribution, pathology and pathogenesis of lumbar interspinous bursitis (described as a clinical syndrome by Baastrup in 1933). It is based on an anatomic study of 152 lumbar spines derived from routine and random postmortem material, together with selected specimens from autopsies on patients with various rheumatic diseases. From a statistical study of 50 randomly chosen spines, bursae are found when the interspinous distance is small compared with the total height of the lumbar spine ('bursal index'): nearly all bursal spaces show some sign of inflammation and a few show severe bony erosion. Crystal deposits therein are also described. PMID:7178764

  12. My approach to performing a perinatal or neonatal autopsy

    PubMed Central

    Wainwright, H C

    2006-01-01

    An opportunity to determine the cause of death, factors that may have a role in it, and the extent and cause of malformations is provided by perinatal autopsy. The family may be assisted in finding closure after the death of their infant by the information obtained. Insight into classifying infants appearing normal into one of three groups, small, appropriate and large for gestational age, has been provided, as each group tends to have specific causes of death. In infants with congenital anomalies, patterns of malformation may lead us to the diagnosis. An accurate diagnosis is required to provide counselling for a subsequent pregnancy. PMID:16803946

  13. Prenatal Diagnosis of Uhl Anomaly with Autopsy Correlation.

    PubMed

    Philip, Saji; Bharati, Sarasa; Cherian, Kottureth Mammen; Bharati, Saroja

    2016-03-01

    Uhl anomaly is a rare form of congenital hypoplasia of the right ventricular myocardium. Here, we report, a rare finding in fetal cardiac ultrasound in a 33-year-old woman who presented at 20 weeks' of gestation. A diagnosis of Uhl anomaly was made. An autopsy was performed at 23weeks gestation after obtaining permission for medicolegal termination of pregnancy. Histopathological examination confirmed the diagnosis. Diagnosing Uhl anomaly in fetal life is essential since mortality and survival mainly depend on the severity of right ventricle dysfunction related to, the either partial or complete absence of the myocardium. Hence, surviving cases need to be followed up carefully and counselled accordingly. PMID:26929879

  14. Prenatal Diagnosis of Uhl Anomaly with Autopsy Correlation

    PubMed Central

    Philip, Saji; Bharati, Sarasa; Cherian, Kottureth Mammen; Bharati, Saroja

    2015-01-01

    Uhl anomaly is a rare form of congenital hypoplasia of the right ventricular myocardium. Here, we report, a rare finding in fetal cardiac ultrasound in a 33-year-old woman who presented at 20 weeks' of gestation. A diagnosis of Uhl anomaly was made. An autopsy was performed at 23weeks gestation after obtaining permission for medicolegal termination of pregnancy. Histopathological examination confirmed the diagnosis. Diagnosing Uhl anomaly in fetal life is essential since mortality and survival mainly depend on the severity of right ventricle dysfunction related to, the either partial or complete absence of the myocardium. Hence, surviving cases need to be followed up carefully and counselled accordingly. PMID:26929879

  15. [Watching, listening and sharing: field work for psychosocial autopsies].

    PubMed

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

    2012-08-01

    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. PMID:22899144

  16. Prospective study of coroner's autopsies in Benin City, Nigeria.

    PubMed

    Aligbe, J U; Akhiwu, W O; Nwosu, S O

    2002-10-01

    A prospective study of 726 cases of coroner's autopsies carried out over a period of two years (1st January, 1996 - 31st December, 1997) was reviewed. The causes and circumstances of death are defined and classified into natural and unnatural deaths. Fifty cases (6.3%) were children while the remaining 676 cases (93.1%) were adults in a male to female ratio of 2.6 to 1. The most common indications for coroner's autopsies were sudden unnatural deaths (SUDs) accounting for 485 cases (66.8%) and also sudden unexpected natural deaths (SUNDs) (241 cases) accounting for 33.2%. In the first category, road traffic accidents accounted for 86.7% of cases with deaths involving motor vehicle drivers and their passengers (41.8%); pedestrians (37.1%); and motorcyclists and their passengers (18.6%). The commonest causes of death in all road traffic accidents were craniocerebral injuries and haemorrhagic shock. In the second category the most common causes of sudden unexpected natural death were cardiovascular diseases resulting from complications of hypertension (54.7%) occurring in apparently healthy individuals. Other causes of death were pneumonia, pulmonary tuberculosis, typhoid fever and neoplastic diseases. This study showed that in Nigeria, with an increasing acquisition of dietary and life style habits of the developed western world, there is becoming a concomitant risk of deaths from road traffic accidents and sudden unexpected natural deaths from hypertensive cardiovascular disease. PMID:12487517

  17. Mucolipidosis IV: morphology and histochemistry of an autopsy case.

    PubMed

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

    1995-03-01

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

  18. An autopsy case of fatal repellent air freshener poisoning.

    PubMed

    Hitosugi, Masahito; Tsukada, Chie; Yamauchi, Shinobu; Matsushima, Kazumi; Furukawa, Satoshi; Morita, Satomu; Nagai, Toshiaki

    2015-09-01

    We describe a first fatal case of repellent air freshener ingestion. A 79-year-old Japanese man with Alzheimer-type senile dementia orally ingested repellent air freshener containing three surfactants: polyoxyethylene 9-lauryl ether, polyoxyethylene (40) hydrogenated castor oil, and lauric acid amidopropyl amine oxide (weight ratio of 1.3%). About 1h after the collapse, he was in cardiopulmonary arrest and subsequently died 10h after his arrival. The forensic autopsy performed 5.5h after death revealed the 380ml of stomach contents with a strong mint perfume identical to that of the repellent air freshener and the findings of acute death. Toxicologically, 9.1μg/ml and 558.2μg/ml of polyoxyethylene 9-lauryl ether were detected from the serum and stomach contents taken at autopsy. Generally, ingestion of anionic or non-ionic surfactants have been considered as safe. However, because the patient suffered from cardiac insufficiency with a low dose of repellent air freshener ingestion, medical staff members must evaluate the elderly patient for cardiac and circulatory problems regardless of the ingested dose. Not only medical and nursing staff members, but also families who are obliged to care for elderly persons must be vigilant to prevent accidental ingestion of toxic substances generally used in the household. PMID:25982958

  19. [An Autopsy Case of Abnormal Behaviour Induced by Zolpidem].

    PubMed

    Usumoto, Yosuke; Kudo, Keiko; Sameshima, Naomi; Sato, Kazuo; Tsuji, Akiko; Ikeda, Noriaki

    2015-06-01

    Zolpidem is a widely used ultrashort-acting non-benzodiazepine in clinical practice; compared with benzodiazepines, it does not have side effects such as daytime hangover, rebound insomnia, and development of tolerance. We report an autopsy case of abnormal behaviour induced by zolpidem. A man in his 60's had suffered from postherpetic neuralgia about 2 months ago and had been prescribed zolpidem for insomnia. According to his family, he had no memory of his actions such as striking a wall, taking his futon outside, and eating 5 times a day after he took zolpidem. Because his postherpetic neuralgia did not improve, he was hospitalized and treated with an epidural block. During hospitalization, he took off his clothes, removed the epidural block catheter by himself, and slept on others' beds. He disappeared from the hospital one day; the next day, he was found dead in a narrow water storage tank 10 km away from the hospital. He was thought to have driven a car by himself to reach the place. Forensic autopsy revealed that the cause of death was drowning. Zolpidem and several other drugs were detected by toxicological analysis of his blood; the concentrations of these drugs were within therapeutic range. There are several reports about somnambulism induced by zolpidem such as sleepwalking, sleep driving, and eating. Considering the strange episodes following zolpidem administration, his behaviour on the day of his death was considered abnormal behaviour induced by zolpidem. PMID:26306385

  20. Psychological autopsy studies as diagnostic tools: are they methodologically flawed?

    PubMed

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

    2012-08-01

    One of the most established "truths" in suicidology is that almost all (90% or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliability and validity of this method. For example, psychiatric diagnoses are assigned to people who have died by suicide by interviewing a few of the relatives and/or friends, often many years after the suicide. In this article, we scrutinize PA studies with particular focus on the diagnostic process and demonstrate that they cannot constitute a valid evidence base for a strong relationship between mental disorders and suicide. We show that most questions asked to assign a diagnosis are impossible to answer reliably by proxies, and thus, one cannot validly make conclusions. Thus, as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants' relationships with the deceased. PMID:24563941

  1. Occupational exposure to formaldehyde in a medical center autopsy service

    SciTech Connect

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

    1983-07-01

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

  2. An Autopsy of Nanofiltration Membrane Used for Landfill Leachate Treatment

    PubMed Central

    Demir, Ibrahim; Koyuncu, Ismail; Guclu, Serkan; Yildiz, Senol; Balahorli, Vahit; Caglar, Suphi; Turken, Turker; Pasaoglu, Mehmet E.; Kaya, Recep; Sengur-Tasdemir, Reyhan

    2015-01-01

    Komurcuoda leachate treatment plant, Istanbul, which consists of membrane bioreactor (MBR) and nanofiltration (NF) system, faced rapid flux decline in membranes after 3-year successful operation. To compensate rapid flux decline in membranes, the fouled membranes were renewed but replacement of the membranes did not solve the problem. To find the reasons and make a comprehensive analysis, membrane autopsy was performed. Visual and physical inspection of the modules and some instrumental analysis were conducted for membrane autopsy. Membranes were found severely fouled with organic and inorganic foulants. Main foulant was iron which was deposited on surface. The main reason was found to be the changing of aerator type of MBR. When surface aerators were exchanged with bottom diffusers which led to increasing of dissolved oxygen (DO) level of the basin, iron particles were oxidized and they converted into particulate insoluble form. It was thought that probably this insoluble form of the iron particles was the main cause of decreased membrane performance. After the diagnosis, a new pretreatment alternative including a new iron antiscalant was suggested and system performance has been recovered. PMID:26137593

  3. Autopsy of an Egyptian mummy (Nakht--ROM I).

    PubMed Central

    1977-01-01

    Autopsy of a 3200-year-old Egyptian mummy by an international multidisciplinary team yielded much information about diseases of the ancient past. Major contributions were made by the disciplines of anatomy, dentistry, genetics, hematology, histology, microbiology, nuclear medicine, occupational medicine, orthopedic surgery, otolaryngology, pathology, pediatrics, plastic surgery, radiology and virology. Scientists from Toronto, Detroit, Philadelphia and Cardiff participated in the investigation. The following were the main findings of medical interest: skeleton, infection or malnutrition as suggested by Harris's lines in distal femoral metaphyses; muscle (intercostal), cyst of Trichinella spiralis; lungs, deposits of anthracotic pigment and granite particles; spleen, enlargement with evidence of possible rupture; liver, early cirrhosis and calcified ova of Schistosoma sp.; kidney, calcified ova of Schistosoma sp.; and large and small intestines, calcified ova of Schistosoma and Taenia spp. This autopsy demonstrated the value of well coordinated efforts by specialists in various medical disciplines. Such efforts are essential when such a rare scientific endeavour is to yield a maximum of useful and reliable information. PMID:332299

  4. 20 CFR 410.428 - X-ray, biopsy, and autopsy evidence of pneumoconiosis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false X-ray, biopsy, and autopsy evidence of... Pneumoconiosis § 410.428 X-ray, biopsy, and autopsy evidence of pneumoconiosis. (a) A finding of the existence of... roentgenogram (X-ray) establishes the existence of pneumoconiosis classified as Category 1, 2, 3, A, B, or...

  5. 20 CFR 410.428 - X-ray, biopsy, and autopsy evidence of pneumoconiosis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false X-ray, biopsy, and autopsy evidence of... Pneumoconiosis § 410.428 X-ray, biopsy, and autopsy evidence of pneumoconiosis. (a) A finding of the existence of... roentgenogram (X-ray) establishes the existence of pneumoconiosis classified as Category 1, 2, 3, A, B, or...

  6. What Do Parents Want To Know When Considering Autopsy For Their Child With Cancer?

    PubMed Central

    Wiener, Lori; Sweeney, Corinne; Baird, Kristin; Merchant, Melinda S.; Warren, Katherine E.; Corner, Geoffrey W.; Roberts, Kailey E.; Lichtenthal, Wendy G.

    2014-01-01

    Research has suggested that autopsy in pediatrics is a valued way for parents to better understand and process their child's death, yet physicians often express hesitancy in discussing this topic with parents. To better assist clinicians with initiating discussion about this often sensitive topic, the current study examined bereaved parents' preferences about the timing and content of the autopsy discussion as well as reasons for considering autopsy. This study explored the views of 30 parents who lost a child to a variety of malignancies between 6 months and 6 years ago. Results showed that 36.7% of parents recalled having a discussion about autopsy, and the vast majority of those who did not recall a discussion (89.5%) would have considered an autopsy if it had been discussed. The majority of participants in this study indicated their preference to have the first conversation about autopsy when it becomes clear that cure is no longer possible. Findings suggest that educating parents about the clinical, emotional and potential research benefits of autopsy and tissue procurement will ultimately help them make informed decisions and understand the importance of autopsy in medical progress. The future research and clinical implications of these findings are discussed. PMID:24309611

  7. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  8. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  9. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  10. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  11. Autopsy Analysis may Contribute to Establish Actual Incidence of Second Primary Malignancies in Myeloma

    PubMed Central

    Takano, Junichiro; Miwa, Akiyoshi

    2015-01-01

    Second primary malignancies (SPMs) are issues for patients with multiple myeloma (MM). There may have been some limitations in prior studies, such as difficulties in a longer follow-up and absence of established screening methods. Therefore, we studied autopsied cases to overcome these limitations. This study aimed to examine SPMs using autopsy reports. Ninety-one cases of MM autopsied at our institution from 1979 to 2013 were analyzed. Median age of autopsied patients was 64.1 years, and proportion of male/female was 59/32. Autopsy was performed in 35.3% of patients died of MM. There were five cases of SPMs with a median confirmation time of 38 (12-132) months from the diagnosis of MM. In three of the five patients, the diagnosis of SPMs was established at autopsy. One case was of myelodysplastic syndrome, and the others were of non-hematological malignancies. The annual risk of SPM estimated using the Kaplan-Meier method was approximately 1%. Three of five SPM cases were detected at autopsy. Analysis of autopsy may contribute to estimate the actual risk of SPMs in MM. PMID:26788269

  12. SIDS Counselors' Reports of Own and Parents' Reactions to Reviewing the Autopsy Report.

    ERIC Educational Resources Information Center

    Kotch, Jonathan B.; Cohen, Susan R.

    1986-01-01

    The North Carolina Sudden Infant Death Syndrome Project surveyed 47 newly trained local Sudden Infant Death Syndrome counselors to evaluate use of autopsy report as a counseling tool. Counselors reported that sharing the autopsy report with bereaved parents was a valuable part of the counseling process. (Author/NRB)

  13. Is Consent to Autopsy Necessary? Cartesian Dualism in Medicine and Its Limitations.

    PubMed

    Lane, Megan; Vercler, Christian J

    2016-01-01

    When a hospitalization ends in death, a request for an autopsy can lead to an emotionally charged encounter between a physician and the deceased patient's family. A case is presented in which a cardiac surgeon, believing he might have made a mistake, requests an autopsy, but members of the deceased patient's family believe that she would not have wanted an autopsy performed. A central question discussed in this commentary is whether and when consent for autopsy is necessary. We discuss two theoretical frameworks that support differing views on this question. Beyond engaging this philosophical discussion, we also highlight a practical approach to discussing an autopsy with a grieving family by using the case presented. PMID:27550560

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

    PubMed Central

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

    2014-01-01

    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 and 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. PMID:25518020

  15. Clinical review: What is the role for autopsy in the ICU?

    PubMed Central

    2010-01-01

    The availability of advanced diagnostic tools has grown in the past decades. Hence, a growing false belief exists that everything is known about the patient before death. Moreover, intensivists may wrongly believe that autopsy findings do not contribute to the understanding of pathophysiological events. The immediate result is that few ICUs nowadays assemble enough autopsy cases with new and interesting clinicopathological features. However, we believe that, at least in tertiary ICUs, autopsies remain a valuable examination, as a tool for quality control, as a way of establishing gold standards for diagnostic examinations and as an aid in developing guidelines for treatment and diagnosis of diseases frequently encountered in the ICU. Finally, due to the ever-expanding armamentarium of immunosuppressive agents, a growing list of opportunistic infections is discovered during autopsy. The present article gives an overview of autopsy studies conducted in the ICU and discusses the pros and cons of performing these. PMID:20565845

  16. Reliability of body size measurements obtained at autopsy: impact on the pathologic assessment of the heart.

    PubMed

    McCormack, Carmen A; Lo Gullo, Roberto; Kalra, Mannudeep K; Louissaint, Abner; Stone, James R

    2016-06-01

    Purpose Assessment of body size at autopsy is important for interpreting organ weight measurements and in some cases body identification. The reliability of post-mortem body size measurements, the causes for perturbations in these measurements from their corresponding pre-mortem values, and the impact of such perturbations on heart weight interpretation have not been fully explored. Methods Autopsy body length and weight measurements and pre-mortem height and body weight measurements were compared in 132 autopsies. Clinical records were evaluated for peripheral edema and serum albumin levels. Causes of death, body cavity fluid collections, and heart weights were obtained from the autopsy reports. A subset of patients underwent quantitative post-mortem computed tomography assessment of anasarca. Results At autopsy, body weight differed from the pre-mortem value by 11 ± 1 %, compared with -0.2 ± 0.3 % for body length (P < 0.0001). The percent change in body weight at autopsy correlated with the presence of peripheral edema (14 ± 2 % vs. 7 ± 2 %, P = 0.01), serum albumin < 3.0 g/dL (16 ± 2 % vs. 7 ± 2 %, P = 0.001), and the degree of anasarca (P = 0.01). In 4 % of autopsies, heart weights were abnormal based on the pre-mortem body weight, but would be classified as normal based on the elevated post-mortem body weight. Conclusions At autopsy, body weight is a less reliable parameter than body length in correlating with the corresponding pre-mortem measurement. Autopsy body weights are elevated in part due to peripheral edema/anasarca. Alterations in body weight at autopsy can confound the interpretation of organ weight measurements. PMID:27020890

  17. The negative autopsy: sudden cardiac death or other?

    PubMed

    Cohle, S D; Sampson, B A

    2001-01-01

    One of the most frustrating challenges faced by the forensic pathologist is the inability to determine the cause of death in a young person previously thought healthy. The four steps in the investigation of a sudden death include obtaining the history and scene information, performing a gross and microscopic autopsy, performing appropriate laboratory tests, and making the diagnosis. When examining the heart grossly it is important to preserve the anatomic landmarks, section the coronary arteries closely, and recognize lethal abnormalities such as anomalous origin of the coronary arteries. Specimens useful for toxicologic analysis include whole blood, serum, vitreous humor, gastric contents, bile, urine a purple top tube of blood, and frozen myocardium and spleen. Lethal cardiac diseases with minimal or no anatomic findings include Brugada and Garg's syndromes, the long QT syndrome, and Wolff-Parkinson-White (WPW) syndrome. Consultation with other experts, including cardiac pathologists, cardiologists, electrophysiologists, and molecular biologists, may be helpful in determining a cause of death. PMID:11673059

  18. Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case.

    PubMed

    Matsuda, Katsuya; Yamaryo, Takeshi; Akazawa, Yuko; Kawakami, Kenji; Nakashima, Masahiro

    2015-11-01

    We report a case of pleural angiosarcoma in an adult male patient confirmed by autopsy and possibly associated with pneumoconiosis. The lesion was characterized by thickened pleura of both lungs with nodular tumors. Histologically, the tumor was composed of spindle-to-polygonal epithelioid cells that were positive for CD31, CD34, vimentin, and cytokeratin on immunohistochemical staining but were negative for calretinin. Further examination revealed mix-dust pathological findings consistent with the existence of pneumoconiosis; dystrophic ossification, anthracosis, and fractal small dust particles were observed in the lung parenchyma and a hilar lymph node. The current case suggests that pneumoconiosis-associated pathologies may be risk factors for the development of angiosarcoma in the pleura. PMID:26314557

  19. Semilobar holoprosencephaly with 21q22 deletion: an autopsy report

    PubMed Central

    Mallick, Saumyaranjan; Panda, Shasanka Shekhar; Ray, Ruma; Shukla, Rashmi; Kabra, Madhulika; Agarwal, Ramesh

    2014-01-01

    Holoprosencephaly (HPE) is the most common forebrain developmental anomaly with a prevalence of 1:16 000 live-births. Possible aetiological agents include environmental factors and genetic defects such as trisomies (13, 18) and deletions (18p, 7q, 2p and 21q). This complex malformation is due to incomplete division of the cerebral hemisphere. The phenotypes of HPE include alobar, semilobar, lobar and midline interhemispheric fusion variants. Craniofacial anomalies occur in 80% of cases. Severely affected babies die in the neonatal period. Here we report an autopsied case of semilobar HPE with pituitary and adrenal agenesis with 21q22 deletion. Additional findings are noted that would help expand the spectrum of 21q22 deletion. PMID:24626384

  20. Suicide note and the psychological autopsy: Associated behavioral aspects.

    PubMed

    Acinas, Maria Patricia; Robles, José I; Peláez-Fernández, M Ángeles

    2015-01-01

    When a death occurs under traumatic, ambiguous, unknown, or uncertain circumstances, a death of suicidal origin can be considered. On many occasions, a suicide note is found next to body that helps to clarify certain aspects needed for the investigation to elucidate whether the death is really due to suicide or other causes. There are several types of suicide note (farewell, instructions, accusation of others, request for forgiveness, justification of one’s own suicide) that can contribute to the study of the victim’s psychological state and the circumstances that led to death. There is no unanimously approved way to conduct the psychological autopsy, but there are protocols for obtaining relevant information and preparing the report. PMID:25999154

  1. Congenital Malformations in Perinatal Autopsies – A Study of 100 Cases

    PubMed Central

    Andola, Uma S; AM, Anita; Ahuja, Mukta; Andola, Sainath K

    2012-01-01

    Background Congenital malformations remain a common cause of perinatal deaths and even though ultrasonogram can give fairly accurate diagnosis, perinatal autopsy is essential to confirm the diagnosis and look for associated malformations. Objectives To emphasize the importance of perinatal autopsy in diagnosing congenital malformations and to compare the same with the prenatal ultrasound findings. Methods The present study comprises 100 consecutive perinatal autopsies conducted after obtaining the approval from the Institutional Ethics Committee. In cases where prenatal ultrasound findings were available they were compared with the autopsy findings. Results Out of 100 perinatal autopsies, 44 cases were congenital anomalies with M:F = 1:1.5. Majority of the fetuses with congenital malformations (36.36%) were therapeutically terminated, Cental nervous system malformations being the commonest indication. The most common timing of therapeutic termination being 20 -24weeks. Congenital malformations were common between 35-39 weeks gestational age and birth weight range 350- 1000g. The malformations involving the central nervous system were commonest, seen in 15 cases (34.09%) followed by renal anomalies in 9 cases (20.45%) and multiple malformations in 7cases ( 15.91%). Autopsy confirmed the prenatal ultrasound findings in 50% of the cases, added to diagnosis in 29.54%, while it completely changed the primary diagnosis in 9.09% of the cases. Conclusion This study highlights the importance of perinatal autopsy in confirming the diagnosis of congenital anomalies by prenatal ultrasound findings. PMID:23373038

  2. [Some findings of the lung in medicolegal autopsy cases].

    PubMed

    Ohya, I

    1994-12-01

    "At first glance the lungs may seem uncomplicated, but many wise men have gone astray in their labyrinths." These words were written by Dr. A.A. Liebow, a famous pathologist, in a foreword to the first edition of Pathology of the Lung by H. Spencer. This same thought can also be applied to the field of medicolegal autopsies. 1. The gross appearance of the lungs in medicolegal autopsies Plucks consisting of the lungs, neck organs, the esophagus and the aorta were removed from human cadavers and after taking photos of the frontal and rear view, the lungs were carefully examined to reveal whether the lung shows characteristic morphological changes depending on causes of death. Based on their appearance, the lungs were classified into the 3 following types: a collapsed, a non-collapsed and an inflated type, each of these types reflecting the probable cause of death. The collapsed type of lung was seen in cases of death from exanguination, and the lung falling into shrinkage due to traumatic pneumo- and/or hemo-thorax was also classified into the collapsed type. The non-collapsed type of lung was seen in cases whose lungs were thermo-coagulated and in a case of death from a pulmonary embolism. Also, the deflating lungs of drowning victims before falling into collapse, were classified into a non-collapsed type. The inflated type of lung consisted of lungs that showed ballooning soon after death by drowning, and lungs that had inflated due to emphysema or edema from various causes. This lung study has reconfirmed that the lungs show hypostatic changes more clearly than any other organs of the body, and in the absence of skin color changes reflecting hypostasis, the settling of the blood in the lung could be detected in most cases. 2. Early histopathological lung changes induced by shock One hundred and thirty medicolegal cases were reviewed to detect early histopathological changes of the lung induced by shock. In many cases of death from various causes, pulmonary edema

  3. Cardiac Channel Molecular Autopsy: Insights From 173 Consecutive Cases of Autopsy-Negative Sudden Unexplained Death Referred for Postmortem Genetic Testing

    PubMed Central

    Tester, David J.; Medeiros-Domingo, Argelia; Will, Melissa L.; Haglund, Carla M.; Ackerman, Michael J.

    2012-01-01

    Objective To perform long QT syndrome and catecholaminergic polymorphic ventricular tachycardia cardiac channel postmortem genetic testing (molecular autopsy) for a large cohort of cases of autopsy-negative sudden unexplained death (SUD). Methods From September 1, 1998, through October 31, 2010, 173 cases of SUD (106 males; mean ± SD age, 18.4±12.9 years; age range, 1-69 years; 89% white) were referred by medical examiners or coroners for a cardiac channel molecular autopsy. Using polymerase chain reaction, denaturing high-performance liquid chromatography, and DNA sequencing, a comprehensive mutational analysis of the long QT syndrome susceptibility genes (KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2) and a targeted analysis of the catecholaminergic polymorphic ventricular tachycardia type 1–associated gene (RYR2) were conducted. Results Overall, 45 putative pathogenic mutations absent in 400 to 700 controls were identified in 45 autopsy-negative SUD cases (26.0%). Females had a higher yield (26/67 [38.8%]) than males (19/106 [17.9%]; P<.005). Among SUD cases with exercise-induced death, the yield trended higher among the 1- to 10-year-olds (8/12 [66.7%]) compared with the 11- to 20-year-olds (4/27 [14.8%]; P=.002). In contrast, for those who died during a period of sleep, the 11- to 20-year-olds had a higher yield (9/25 [36.0%]) than the 1- to 10-year-olds (1/24 [4.2%]; P=.01). Conclusion Cardiac channel molecular autopsy should be considered in the evaluation of autopsy-negative SUD. Several interesting genotype-phenotype observations may provide insight into the expected yields of postmortem genetic testing for SUD and assist in selecting cases with the greatest potential for mutation discovery and directing genetic testing efforts. PMID:22677073

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

    PubMed

    Maujean, Géraldine; Malicier, Daniel; Fanton, Laurent

    2012-03-01

    Today, little is known about the bacteriological environment of the autopsy room and its potential interest for medico-legal practices. Seven hundred fifty microbiological samples were taken from surface (n = 660), air (n = 48), and water (n = 42) to evaluate it in a French University Forensic Department. Median bacterial counts were compared before and during autopsy for air samples, and before and after autopsy for surface samples, using Wilcoxon matched pairs signed ranks test. Bacterial identification relied on traditional phenotypic methods. Bacterial counts in the air were low before autopsy, increased significantly during procedure, and seemed more linked to the number of people in the room than to an important production of aerosol-containing bacteria. Despite cleaning, human fecal flora was omnipresent on surfaces, which revealed insufficient disinfection. Bacteriological sampling is an easy way to monitor cleaning practices in postmortem rooms, but chiefly a way to improve the reliability of medico-legal proofs of infectious deaths. PMID:22309163

  5. 78 FR 38735 - Autopsy Performance Criteria: Standards, Guidelines and Best Practices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF JUSTICE Office of Justice Programs Autopsy Performance Criteria: Standards, Guidelines and Best Practices AGENCY... and Best Practices''. The opportunity to provide comments on this document is open to...

  6. A bite into the history of the autopsy : From ancient roots to modern decay.

    PubMed

    Burton, Julian L

    2005-12-01

    The autopsy has had a checkered history, much of which has been surrounded by controversy. The roots of human dissection are found in the ancient world where rumors flourished that the prosectors of the day were engaged in vivisection as well as dissection. Bound up with the prevailing religious and political systems of the day, the autopsy has alternately been prohibited and encouraged, used to explore the nature of disease, and conceal questionable political policy. This review explores the history of the autopsy from its ancient roots in Egypt, Mesopotamia, Alexandria, and the Far East through the dark ages to medieval times and beyond into the renaissance. The development of the autopsy in Europe during the 17th to 19th centuries is discussed before briefly considering the decline of this diagnostic tool in the 20th century. PMID:25868447

  7. Autopsy Findings in Conjoined Twin with Single Heart and Single Liver

    PubMed Central

    Asaranti, Kar; Pranati, Mohanty; Tushar, Kar; Jagadish, Behera; Susmita, Behera; Amarendra, Nayak

    2012-01-01

    Thoracoomphalopagus is the commonest type of conjoined twin where the bodies are fused from upper chest to lower chest. The autopsy done can help counsil the parents for further pregnancies and determine the prognosis depending upon the type of cardiac anomaly by Seo classification when detected antenatally. We describe the detail pathological autopsy of such a case with single heart and single liver. A detail autopsy was done on the twin fetus. The twins shared a single heart and sometimes the liver and part of digestive system. The combined weight was 4.1 KG. Both were full-term male babies joined from below the nipple till umbilicus. Autopsy in conjoined twins helps in deciding the type of fusion of the body and also of the heart and great vessels. It can help in counseling parents about future pregnancies that there is no chance of recurrence of this abnormality and no need to be scared. PMID:22957286

  8. Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings.

    PubMed

    Yu, Lin-Sheng; Ye, Guang-Hua; Fan, Yan-Yan; Li, Xing-Biao; Feng, Xiang-Ping; Han, Jun-Ge; Lin, Ke-Zhi; Deng, Miao-Wu; Li, Feng

    2015-09-01

    Despite advances in medical science, the causes of death can sometimes only be determined by pathologists after a complete autopsy. Few studies have investigated the importance of forensic autopsy in medically disputed cases among different levels of institutional settings. Our study aimed to analyze forensic autopsy in 120 cases of medical disputes among five levels of institutional settings between 2001 and 2012 in Wenzhou, China. The results showed an overall concordance rate of 55%. Of the 39% of clinically missed diagnosis, cardiovascular pathology comprises 55.32%, while respiratory pathology accounts for the remaining 44. 68%. Factors that increase the likelihood of missed diagnoses were private clinics, community settings, and county hospitals. These results support that autopsy remains an important tool in establishing causes of death in medically disputed case, which may directly determine or exclude the fault of medical care and therefore in helping in resolving these cases. PMID:25929602

  9. Algorithms for verbal autopsies: a validation study in Kenyan children.

    PubMed Central

    Quigley, M. A.; Armstrong Schellenberg, J. R.; Snow, R. W.

    1996-01-01

    The verbal autopsy (VA) questionnaire is a widely used method for collecting information on cause-specific mortality where the medical certification of deaths in childhood is incomplete. This paper discusses review by physicians and expert algorithms as approaches to ascribing cause of deaths from the VA questionnaire and proposes an alternative, data-derived approach. In this validation study, the relatives of 295 children who had died in hospital were interviewed using a VA questionnaire. The children were assigned causes of death using data-derived algorithms obtained under logistic regression and using expert algorithms. For most causes of death, the data-derived algorithms and expert algorithms yielded similar levels of diagnostic accuracy. However, a data-derived algorithm for malaria gave a sensitivity of 71% (95% Cl: 58-84%), which was significantly higher than the sensitivity of 47% obtained under an expert algorithm. The need for exploring this and other ways in which the VA technique can be improved are discussed. The implications of less-than-perfect sensitivity and specificity are explored using numerical examples. Misclassification bias should be taken into consideration when planning and evaluating epidemiological studies. PMID:8706229

  10. Aspiration-Related Deaths in 57 Consecutive Patients: Autopsy Study

    PubMed Central

    Hu, Xiaowen; Yi, Eunhee S.; Ryu, Jay H.

    2014-01-01

    Background Aspiration can cause a diverse spectrum of pulmonary disorders some of which can lead to death but can be difficult to diagnose. Patients and Methods The medical records and autopsy findings of 57 consecutive patients in whom aspiration was the immediate cause of death at Mayo Clinic (Rochester, MN, USA) over a 9-yr period, from January 1 2004 to December 31 2012 were analyzed. Results The median age at death was 72 years (range, 13–95 years) and included 39 (68%) males. The most common symptom before death was dyspnea (63%) and chest radiography revealed bilateral infiltrates in the majority (81%). Most common precipitating factors for aspiration were depressed consciousness (46%) and dysphagia (44%). Aspiration-related syndromes leading to death were aspiration pneumonia in 26 (46%), aspiration pneumonitis in 25 (44%), and large airway obstruction in 6 patients (11%). Aspiration was clinically unsuspected in 19 (33%) patients. Antimicrobial therapy had been empirically administered to most patients (90%) with aspiration pneumonia and aspiration pneumonitis. Conclusion We conclude aspiration-related deaths occur most commonly in the elderly with identifiable risks and presenting bilateral pulmonary infiltrates. One-third of these aspiration-related pulmonary syndromes were clinically unsuspected at the time of death. PMID:25076409

  11. Associated anomalies with neural tube defects in fetal autopsies.

    PubMed

    Toru, Havva Serap; Sanhal, Cem Yasar; Uzun, Özlem Ceren; Ocak, Guzide Ayse; Mendilcioğlu, İnanç; Karaveli, Fatma Şeyda

    2016-03-01

    Neural tube defects (NTD), the consequences of aberrant neural tube closure during embryogenesis, have been mostly investigated in terms of their high prevalence, rate of mortalities and serious morbidities. A proper prenatal outcome counseling of couples coming across a fetal anomaly necessitates the detection and categorization of the primer abnormality, all the co-existing malformations. The aim of this work is to study the incidence and relevance of associated malformations in order to offer a complete pathology report with a true diagnosis. In this study, among 542 fetal autopsy 62 (%11.4) cases with NTD was recorded by the Akdeniz University Pathology Department between January 2006 and June 2012. Twenty (32.4%) NTD cases were associated with anomaly. Twelve cases of associated groups consisted of a congenital syndrome/association, spondylothoracic dysplasia, amniotic band syndrome, Meckel-Gruber syndrome, schisis association. The frequency of associated NTD was 32%, this result was higher than previous reports. NTDs have a significant genetic component to their etiology that interacts with environmental risk factors, which might pose Turkey to be a country with high prevalence of NTD. We want to emphasize that intensive screening, documentation of co-existent abnormalities of NTD, should be conducted in order to exhibit certain diagnosis, to perform proper prenatal genetic counseling of parents for on-going/future pregnancies. PMID:25800566

  12. Autopsy pathology in the acquired immune deficiency syndrome.

    PubMed Central

    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. Characteristics of young rural Chinese suicides: a psychological autopsy study

    PubMed Central

    Zhang, J.; Wieczorek, W.; Conwell, Y.; Tu, X.-M.; Wu, B. Y.-W.; Xiao, S.; Jia, C.

    2010-01-01

    Background Patterns of suicide rates in China differ in many ways from those in the West. This study aimed to identify the risk factors characteristic for young rural Chinese suicides. Method This was a case-control psychological autopsy (PA) study. The samples were suicides and living controls (both aged 15–34 years) from 16 rural counties of China. We interviewed two informants for each suicide and each control with pretested and validated instruments to estimate psychosocial, psychiatric and other risk factors for suicides. Results The prevalence of mental disorders was higher among the young Chinese who died by suicide than among the living controls, but was lower than among suicides in the West. Marriage was not a protecting factor for suicide among young rural Chinese women, and never-married women who were involved in relationships were about three times more likely to commit suicide than single women who were unattached. Religion/religiosity was not a protecting factor in Chinese suicide, as it tended to be stronger for suicides than for controls. Impulsivity was significantly higher for suicides than for controls. Psychological strain, resulting from conflicting social values between communist gender equalitarianism and Confucian gender discrimination, was associated significantly with suicide in young rural Chinese women, even after accounting for the role of psychiatric illness. Conclusions Risk factors for suicide in rural China are different from those in the West. Psychological strain plays a role in suicide. Suicide prevention programs in China should incorporate culture-specific considerations. PMID:19656428

  14. Autopsy findings in 14 patients with penile squamous cell carcinoma.

    PubMed

    Chaux, Alcides; Reuter, Victor; Lezcano, Cecilia; Velazquez, Elsa; Codas, Ricardo; Cubilla, Antonio L

    2011-04-01

    The aim of this study was to describe pathologic features found at autopsy of 14 patients with penile cancer. Nine patients died from disseminated disease; 5 of them presented local/regional recurrences. Five patients died from other causes, 2 of them postoperatively. Local recurrence sites were corpus cavernosum, Buck's fascia and urethra, regional skin, and prostate. Metastatic sites were lymph nodes (9 cases), liver (7 cases), lungs (6 cases), heart (5 cases), adrenals, bone and skin (3 cases each), thyroid and brain (2 cases each), and pancreas, spleen, and pleura (1 case each). Patients with heart metastasis had arrhythmias. Patients who died and who did not die from penile cancer had different profiles: low-grade superficial tumors with usual and warty subtypes versus high-grade deeply invasive basaloid or hybrid verrucous/sarcomatoid carcinomas. A natural history model for penile cancer routes of spread is proposed: local intrapeneal, regional and systemic nodes, regional skin, liver, lungs, heart, and other multiple sites. PMID:19411278

  15. Meconium aspiration in the midtrimester fetus: an autopsy study.

    PubMed

    Mortensen, Elin; Kearney, Michael Shelley

    2009-01-01

    We studied the incidence, severity, and significance of intrauterine meconium aspiration (IUMA) in the midtrimester fetus. Lung sections from 219 midtrimester fetuses were examined for meconium, identified by finding meconium corpuscles. There were 21 cases (9.6%) with IUMA. Gestational age ranged from 13 to 23 weeks (mean 18.7 weeks); 11 were female, and 10 were male. Eighteen were spontaneous abortions, 11 of which were macerated, and 1 of these was associated with an intrauterine contraceptive device. There were 3 terminations of pregnancy, 2 for fetal abnormality and 1 for severe preeclampsia. One fetus was conceived by in vitro fertilization. Fifteen cases (71.4%) showed slight IUMA, 5 cases (23.8%) showed moderate IUMA, and in 1 case (4.8%) IUMA was massive. The incidence of IUMA in an autopsy series of midtrimester fetuses was 9.6%. The amount of aspirated meconium was usually small and possibly physiologic. When IUMA was moderate or massive, it was associated with severe abnormality of the umbilical cord or placenta, particularly subchorionic hematoma. PMID:19323599

  16. [Rembrandt's lessons of anatomy: autopsy as the last act of torment performance].

    PubMed

    Baranski, J

    1998-01-01

    The paper discusses the problem of autopsy in the XVII century. As inspiration for reflections some paintings of Rembrandt are used. Autopsy merges in them as the last, though not the only one, act of body torment performance, thanks to which not only the secrets of human body interior but also empirical horizons of medical research are disclosed. The intellectual background of that period (Bacon's empiricism, rationalism of Descartes, mechanics) allows for medical experience and scientific knowledge about the human body. PMID:11625459

  17. Perinatal Autopsy Findings in a Case of De Novo Hypohidrotic Ectodermal Dysplasia

    PubMed Central

    Chikkannaiah, Panduranga; Nagaraju, Smitha; Kangle, Rajit; Gosavi, Mansi

    2015-01-01

    Ectodermal dysplasia are group of inherited disorders involving the developmental defects of ectodermal structures like hair, teeth, nails, sweat glands, and others. X-linked recessive inheritance is most common. Here we describe perinatal autopsy findings in a case of de novo ectodermal dysplasia in a female fetus. To the best of our knowledge, this is the first fetal autopsy description in a case of ectodermal dysplasia. PMID:26417167

  18. Computerized Tomography Scanning and Magnetic Resonance Imaging Will Terminate the Era of the Autopsy - A Hypothesis

    PubMed Central

    Benharroch, Daniel; Shvarts, Shifra; Jotkowitz, Alan; Shelef, Ilan

    2016-01-01

    Background: Reports on a marked reduction of the number of autopsies performed worldwide to less than 5% of hospital deaths remain without a satisfactory explanation. The premature disappearance of the autopsy might represent a medical tragedy of a major order. One of the causes for the decrease in autopsies is poorly documented: we suspect that the attending physician might show some reluctance when requesting a consent for an autopsy from the bereaved family. Moreover, this officer might consider that the post mortem will add little information to that already obtained from the computerized tomography scanner or the magnetic resonance imaging. Methods: In order to confirm our hypothesis, we carried out a review of 300 articles indexed as "radiologic-histologic correlation", 118 of which were selected for a significant correlation. From the abstracts, we retrieved the type of the article, the degree of correlation as assessed by the authors and the form of imaging employed, and we computed them. Results & conclusions: The most striking correlation was observed in the small prospective series. An additional search for the "radiologic-autopsy correlation" supported a marked reduction in the number of post-mortems, especially those related with prospective studies. Based on the present study, we cannot determine precisely the role of the house officer in this tragedy. We may have demonstrated, however, that the modern radiologic methods have not yet reached a high enough performance quality to achieve the status of a candidate substitute for the autopsy. PMID:26722367

  19. Tales from the grave: Opposing autopsy reports from a body exhumed.

    PubMed

    Gunasekera, R S; Brown, A B; Costas, E H

    2012-07-01

    We report an autopsy case of a 42-year-old woman who, when discovered, had been dead in her apartment for approximately 1 week under circumstances involving treachery, assault and possible drug overdose. This case is unique as it involved two autopsies of the deceased by two different medical examiners who reached opposing conclusions. The first autopsy was performed about 10 days after death. The second autopsy was performed after an exhumation approximately 2 years after burial. Evidence collected at the crime scene included blood samples from which DNA was extracted and analysed, fingerprints and clothing containing dried body fluids. The conclusion of the first autopsy was accidental death due to cocaine toxicity; the conclusion of the second autopsy was death due to homicide given the totality of evidence. Suspects 1 and 2 were linked to the death of the victim by physical evidence and suspect 3 was linked by testimony. Suspect 1 received life in prison, and suspects 2 and 3 received 45 and 20 years in prison, respectively. This case indicates that cocaine toxicity is difficult to determine in putrefied tissue and that exhumations can be important in collecting forensic information. It further reveals that the combined findings of medical examiners, even though contradictory, are useful in determining the circumstances leading to death in criminal justice. Thus, this report demonstrates that such criminal circumstances require comparative forensic review and, in such cases, scientific conclusions can be difficult. PMID:22687773

  20. Changing times: DNA resequencing and the "nearly normal autopsy".

    PubMed

    Karch, Steven B

    2007-10-01

    No matter how meticulous the autopsy, non-traumatic deaths in the young go unexplained from 5-10% of the time. The percentage is higher in children and young adults. Advances in molecular biology and DNA technology now make it possible to explain many of those deaths. This development is not without irony. At the same time that many clinicians are expressing frustration about the lack of tangible gains provided by the Human Genome Project [Greenhalgh T. The Human Genome Project. J R Soc Med. Dec 2005;98(12):545], and pathologists are wondering about the viability of their field, DNA technology is about to reshape the field of forensic pathology. Emerging evidence suggests that the underlying cause of death in many is genetic, and that both the heart and liver abnormalities can both play a role. The problem is that death from a wide variety of genetic defects may leave no histological markers. The ability to identify these "invisible diseases" with postmortem genetic testing has become a reality far more quickly than anyone had ever imagined. The US Food and Drug Administration is about to place "black box" warnings on warfarin advising doctors screen potential recipients for the ability to metabolize that drug and the American Heart Association has recently editorialized that because of genetic-induced variations in electrical conduction that all newborns should have a screening electrocardiogram before they leave the hospital. The introduction of large-scale genetic screening will have an enormous effect on the practice of forensic pathology, far beyond anything seen in our lifetimes. It will also change the practice of medicine as we know it. This paper reviews the current status of the problem. PMID:17720589

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

    PubMed

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

    2013-08-01

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

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

    PubMed

    Folio, R Les; Harcke, H Theodore; Luzi, Scott A

    2009-04-01

    Radiology-assisted autopsy traditionally has been plain film-based, but now is being augmented by computed tomography (CT). The authors present a two-fatality rotary wing crash scenario illustrating application of advanced radiographic techniques that can guide and supplement the forensic pathologist's physical autopsy. The radiographic findings also have the potential for use by the aircraft mishap investigation board. Prior to forensic autopsy, the two crash fatalities were imaged with conventional two-dimensional radiographs (digital technique) and with multidetector CT The CT data were used for multiplanar two-dimensional and three-dimensional (3D) image reconstruction. The forensic pathologist was provided with information about skeletal fractures, metal fragment location, and other pathologic findings of potential use in the physical autopsy. The radiologic autopsy served as a supplement to the physical autopsy and did not replace the traditional autopsy in these cases. Both individuals sustained severe blunt force trauma with multiple fractures of the skull, face, chest, pelvis, and extremities. Individual fractures differed; however, one individual showed hand and lower extremity injuries similar to those associated with control of the aircraft at the time of impact. The concept of "control injury" has been challenged by Campman et al., who found that control surface injuries have a low sensitivity and specificity for establishing who the pilot was in an accident. The application of new post mortem imaging techniques may help to resolve control injury questions. In addition, the combination of injuries in our cases may contribute to further understanding of control surface injury patterns in helicopter mishaps. PMID:19378913

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

    PubMed

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

    2013-07-01

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

  4. Evaluating the Cause of Death in Obese Individuals: A Ten-Year Medical Autopsy Study

    PubMed Central

    Saab, Jad; Salvatore, Steven P.

    2015-01-01

    Background. Obesity is a growing public health problem associated with increased morbidity and rate of death. Postmortem examination is imperative to determine the cause of death, to detect clinically unsuspected disease entities, and consequently to determine the actual impact of obesity on patient mortality. Methods. A total of 849 adult autopsies were retrospectively reviewed. Obese (BMI ≥ 30 kg/m2) and nonobese patients were separately studied. The primary cause of death in each group was categorized into malignancy, infection, stroke, ischemic and nonischemic heart disease, pulmonary embolism, hemorrhage, and primary nonneoplastic diseases of different organ systems. Results. Of 849 autopsies, 32.3% were obese. The leading causes of death in the obese population were malignancy (31.4%), infection (25.9%), ischemic heart disease (12.8%), and pulmonary embolism (6.2%). Obese individuals were statistically more likely to die from pulmonary embolism and liver disease and less likely to die from neurologic diseases and nonischemic heart disease. Conclusion. Autopsies on obese individuals constitute a third of all adult medical autopsies in our center. Increased death rates in the obese due to pulmonary embolism and liver disease should receive special clinical attention. Autopsy findings in the obese population should contribute to overall premortem disease detection, prevention, and management. PMID:25653872

  5. [Generalized septic infections in rheumatoid arthritis. Study of autopsy material].

    PubMed

    Bély, M; Apáthy, A

    1994-11-01

    In the randomized autopsy material of 161 patients with rheumatoid arthritis (RA), a letal, generalized septic infection (GSI) was observed in 22 cases (13.66%). The GSI was accompanied by a pyarthros in 12 (7.45%) and no pyarthros in 10 (6.21%) cases. The clinical parameters of 22 septic RA patients were compared with 139 age and sex matched RA patients without GSI. The average age of septic patients decreased (p < 0.02), with low serum electrophoretic b-globulin level (p < 0.04), and high Waaler-Rose (p < 0.02) and Latex level (p < 0.004). The clinical parameters of 22 septic patients were compared with 76 age and sex matched RA patients without sepsis, vasculitis, or generalized secondary amyloidosis (GSA), and/or miliary epitheloid granulomas of tuberculous type (mT). The differences between the two groups of patients were the same, with a statistically more pronounced age difference (p < 0.005). 29 out of 161 patients (18.01 %) suffered from a clinically manifest diabetes mellitus (in 6 patients accompanied by sepsis), and 11 (6.83 %) from a clinically latent diabetes mellitus (in 2 patients accompanied by sepsis). There was no significant relationship between sepsis and manifest diabetes mellitus. The controlled and treated diabetes mellitus does not influence the frequency of lethal sepsis. Significant correlations were found between sepsis and latent diabetes mellitus (based on the histological detection of amyloid deposition localized to the islets of Langerhans (p < 0.02). 34 out of 161 patients (21.12%) suffered from a generalized secondary amyloidosis (in 3 patients accompanied by sepsis). There was no significant relationship between sepsis and generalized secondary amyloidosis. The thickness of adrenal cortex represents the effect of steroid therapy. Critical random check, using the Mann-Whitney tests, supports significance relationship between the adrenal cortex atrophy and fatal sepsis (p < 0.010). The follicular lymphoid depletion in the spleen

  6. Pulmonary mucormycosis with embolism: two autopsied cases of acute myeloid leukemia.

    PubMed

    Kogure, Yasunori; Nakamura, Fumihiko; Shinozaki-Ushiku, Aya; Watanabe, Akira; Kamei, Katsuhiko; Yoshizato, Tetsuichi; Nannya, Yasuhito; Fukayama, Masashi; Kurokawa, Mineo

    2014-01-01

    Mucormycosis is an increasingly important cause of morbidity and mortality for patients with hematological malignancies. The diagnosis of mucormycosis usually requires mycological evidence through tissue biopsy or autopsy because the signs and symptoms are nonspecific and there are currently no biomarkers to identify the disease. We herein present two autopsied cases of acute myeloid leukemia with prolonged neutropenia who developed invasive mucormycosis accompanied by pulmonary artery embolism. Our cases were featured by unexplained fever and rapidly progressive dyspnea. Computed tomography scan detected nodular lesions or nonspecific consolidations in the lungs. Cultures, cytological study, and serum fungal markers consistently gave negative results. Autopsy revealed embolism of the pulmonary artery which consisted of fibrin clots by filamentous fungi. Genomic DNA was extracted from the paraffin-embedded clots and was applied to polymerase chain reaction amplification, leading to the diagnosis of infection by Rhizopus microsporus. We should carefully search for life-threatening pulmonary embolism when patients with hematological malignancies develop pulmonary mucormycosis. PMID:25031775

  7. Mortality and causes of death in Jordan 1995-96: assessment by verbal autopsy.

    PubMed Central

    Khoury, S. A.; Massad, D.; Fardous, T.

    1999-01-01

    Mortality indicators and causes of death in Jordan were assessed by verbal autopsy. A random sample of 100 clusters of ca. 300 households each were monitored for one year by notification assistants selected from the study area itself. Registered deaths were reported to research assistants who visited the family to complete the verbal autopsy form, which was structured and contained about 100 questions. Causes of death were determined by two physicians according to preset algorithms. A total of 965 deaths were reported among 198,989 persons, giving a crude death rate of 5 per 1000 population per year. The three leading causes of death were diseases of the circulatory system, malignancies and accidents. In the absence of a health information system, verbal autopsy as implemented in Jordan can serve as a reliable substitute. PMID:10516786

  8. Forensic autopsy practice in the Middle East: comparisons with the west.

    PubMed

    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

  9. Usefulness of the Population Health Metrics Research Consortium gold standard verbal autopsy data for general verbal autopsy methods

    PubMed Central

    2014-01-01

    Background Verbal Autopsy (VA) is widely viewed as the only immediate strategy for registering cause of death in much of Africa and Asia, where routine physician certification of deaths is not widely practiced. VA involves a lay interview with family or friends after a death, to record essential details of the circumstances. These data can then be processed automatically to arrive at standardized cause of death information. Methods The Population Health Metrics Research Consortium (PHMRC) undertook a study at six tertiary hospitals in low- and middle-income countries which documented over 12,000 deaths clinically and subsequently undertook VA interviews. This dataset, now in the public domain, was compared with the WHO 2012 VA standard and the InterVA-4 interpretative model. Results The PHMRC data covered 70% of the WHO 2012 VA input indicators, and categorized cause of death according to PHMRC definitions. After eliminating some problematic or incomplete records, 11,984 VAs were compared. Some of the PHMRC cause definitions, such as ‘preterm delivery’, differed substantially from the International Classification of Diseases, version 10 equivalent. There were some appreciable inconsistencies between the hospital and VA data, including 20% of the hospital maternal deaths being described as non-pregnant in the VA data. A high proportion of VA cases (66%) reported respiratory symptoms, but only 18% of assigned hospital causes were respiratory-related. Despite these issues, the concordance correlation coefficient between hospital and InterVA-4 cause of death categories was 0.61. Conclusions The PHMRC dataset is a valuable reference source for VA methods, but has to be interpreted with care. Inherently inconsistent cases should not be included when using these data to build other VA models. Conversely, models built from these data should be independently evaluated. It is important to distinguish between the internal and external validity of VA models. The effects of

  10. Is the diagnostic yield influenced by the indication for fetal autopsy?

    PubMed

    Puri, Ratna Dua; Kotecha, Udhaya; Lall, Meena; Dash, Pratima; Bijarnia-Mahay, Sunita; Verma, Ishwar Chander

    2016-08-01

    The utility of fetal autopsy to corroborate antenatal ultrasound findings and to aid genetic counseling is well known. However, the ability to identify an underlying cause for the common indications for which it is performed is not well studied. This study aimed to determine if the diagnostic yield of fetal autopsy in identifying the underlying cause is determined by the indication of the autopsy. Five groups of fetuses were defined based on the indication for the autopsy performed in 903 cases: (i) malformations, (ii) intrauterine death (IUD), (iii) cystic hygroma and hydrops fetalis, (iv) isolated abnormalities of amniotic fluid, and (v) intrauterine growth restriction (IUGR). The highest diagnostic yield was in fetuses with isolated abnormalities of amniotic fluid (77%), followed by those with IUGR (75%), with IUD (69.6%), those in group five (55.2%) and lowest (45%) in fetuses with malformations (P < 0.001). A cause was identified in 77.8% fetuses with multiple malformations compared to 37.5% with isolated malformations (P < 0.001), with chromosomal abnormalities in 31.8% versus 9.9% respectively (P < 0.001) and malformation syndromes in 42.5% versus 26.3% (P < 0.001). Placental examination provided the highest yield in IUD, IUGR, and oligohydramnios (43.1%; P < 0.003) whereas chromosomal analysis was most useful in cystic hygroma/NIHF (28.9%; P < 0.001). This information on the diagnostic yield in fetal autopsy related its common indications, can be utilized to counsel families of the utility of autopsy to establish cause and recurrence risks and thereby assist then to make an informed decision to consent for the procedure. © 2016 Wiley Periodicals, Inc. PMID:27197608

  11. A case control study on autopsy findings in sudden unexplained nocturnal death syndrome

    PubMed Central

    Gervacio, G; Lim, M; Reganit, P; Encinas, M; Macapugay, L; Palmero, J; Nierras, C; De los Reyes, C; Geronimo, F

    2014-01-01

    Aim Sudden unexplained nocturnal death syndrome (SUNDS) has been linked to the Brugada syndrome. In some places, acute haemorrhagic pancreatitis is widely held to cause it. We conducted a systematic, controlled autopsy study on Filipino SUNDS victims to rule out structural heart findings as well as acute haemorrhagic pancreatitis as causes. Methods and results A case control autopsy study was conducted comparing SUNDS victims between 18 and 50 years of age who died within 1 h of symptom onset with age- and gender-matched controls. There were 24 SUNDS (mean age 34.5 years) and 24 controls (mean 32.7 years). The autopsy incidence of structural heart disease was 8.3% (95% CI (1% to 27%)) and focal pancreatic haemorrhage was 4.17% (95% CI (0.1% to 20%)) but zero for true acute haemorrhagic pancreatitis among SUNDS victims. Autopsy findings in SUNDS versus controls were not significantly different from each other, showing no diagnostic abnormality in any of the organs. There was no significant difference in the incidence of acute haemorrhagic pancreatitis in both the SUNDS and control groups. We did not find fetal dispersion of the atrioventricular (AV) node, sclerosis or fibrosis of the AV conduction system, in a substudy of SUNDS cases. Conclusions We have shown that there is no significant difference in the overall autopsy findings between SUNDS and controls. Autopsy findings were normal in 70% of SUNDS; no cardiac structural pathology was found in 87% of cases. Haemorrhagic pancreatitis is the cause of death in a minority of SUNDS. The cardiac conduction system is normal in a subgroup of SUNDS studied. PMID:27326155

  12. Pleural plaques and risk of cancer in Turin, northwestern Italy. An autopsy study

    SciTech Connect

    Mollo, F.; Andrion, A.; Colombo, A.; Segnan, N.; Pira, E.

    1984-10-01

    The relationship between the occurrence of neoplastic diseases and the presence of pleural plaques was studied in a series of 1097 autopsies performed in Turin from the adult general population. In men, pleural plaques showed an association with the presence of laryngeal, pulmonary, esophageal, and colorectal cancer. Only cancer of the larynx was strongly related to the occurrence of such pleural changes. This autopsy investigation confirms previous observations by others based on x-ray findings, and suggests that pleural plaques may be regarded as risk indicators of possibly asbestos-related tumors in the general population.

  13. Clinical utility and impact of autopsies on clinical practice among doctors in a large teaching hospital in Ghana

    PubMed Central

    Tette, Edem; Yawson, Alfred E.; Tettey, Yao

    2014-01-01

    Background Autopsies can provide a good indication of the quality of patient care, in terms of the accuracy of clinical diagnosis and the quality of treatment given. Designs This was a cross-sectional study among clinicians at the Korle-Bu Teaching Hospital (KBTH) in 2012. Data were collected with a 69-item, self-administered, structured questionnaire. A total of 215 questionnaires were sent out and 119 clinicians responded. Data were collected on the benefits and utility of autopsies for medical practice, care of patients, and management of clinical wards. Survey data were analyzed by simple descriptive statistics (i.e. proportions, ratios, and percentages). Data were analyzed using SPSS version 21. Objective This study examined the views of clinicians regarding the utility of autopsies and their influence on clinical practice in a large teaching hospital in Ghana. Results Overall, clinicians in KBTH agreed that autopsy reports are useful in answering clinical questions (55/119; 46.2%), confirming or verifying clinical diagnoses (54/119; 45.4%), providing information on unsuspected diagnoses (40/119; 33.6%), and for medical education (90/119; 75.6%). Overall, 70/119 (58.8%) of clinicians agreed that autopsy findings improve completeness and reliability of death certification and provide information on clinical effectiveness of treatment and patient management. However, only 23/119 (19.3%) of sampled clinicians had personal interactions with a pathologist during autopsy processes and 93/119 (78.2%) had not attended any autopsy demonstrations in the past 6 months. Attendance of pathologists at clinicopathological meetings of clinical departments of KBTH was minimal. Unfortunately, the use of autopsy reports for auditing clinical diagnostic performance was not seen as essential. Conclusion Strengthening the interaction between doctors and pathologists is essential in improving the autopsy process and utilization in the hospital. KBTH should create opportunities for

  14. The Next Generation of Psychological Autopsy Studies: Part 2. Interview Procedures

    ERIC Educational Resources Information Center

    Conner, Kenneth R.; Beautrais, Annette L.; Brent, David A.; Conwell, Yeates; Phillips, Michael R.; Schneider, Barbara

    2012-01-01

    The psychological autopsy (PA) is a systematic method of assessing the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of suicide decedents. Procedural challenges that need to be addressed to conduct PA interviews are described in this article and…

  15. Quantification of neuropathological findings by image data for the diagnosis of dementia in forensic autopsy cases.

    PubMed

    Takayama, Mio; Kashiwagi, Masayuki; Matsusue, Aya; Waters, Brian; Hara, Kenji; Ikematsu, Natsuki; Kubo, Shin-ichi

    2016-01-01

    The aim of the present study was to quantify neuropathological findings using image analysis software for the diagnosis of dementia in deceased who underwent forensic autopsy. Of the autopsies performed within 48 hours of death and excluding those of patients with head injury, thermal injury, heat stroke, or intracranial lesions, 8 were of autopsy cases clinically diagnosed with dementia and thus included in the dementia group (D). The non-dementia group (non-D) consisted of 6 deceased without dementia. To compare the D and non-D groups, 6 regions and 7 types of pathological findings were observed semi-quantitatively using 4 conventional stainings. Quantitative analysis of collected image data was performed using image analysis software. Semiquantitative analysis of senile plaques and neurofibrillary tangles was performed with Bielschowsky-Hirano's silver staining image data. An easy, simple, and effective quantification method of the pathological findings was achieved. However, no significant differences were observed between the two groups, and diagnosis of dementia by the quantification of pathological findings was not successful. Diagnosis of dementia using image data may be possible in future studies with an increased number of autopsies, and by utilizing staining techniques with higher specificity and sensitivity, such as immunohistochemical staining. PMID:27040064

  16. Generalized arterial calcification of infancy--Findings at post-mortem computed tomography and autopsy.

    PubMed

    Bolster, Ferdia; Ali, Zabiullah; Southall, Pamela; Fowler, David

    2015-09-01

    Generalized arterial calcification in infancy is a rare genetic disorder characterized by abnormal calcification of large and medium sized arteries and marked myointimal proliferation resulting in arterial stenosis. The condition is often fatal secondary to complications of cardiac ischemia, hypertension and cardiac failure. In this report we describe the findings at post mortem computed tomography, histology and autopsy. PMID:26165490

  17. SPERM COUNT, MORPHOLOGY AND FLUORESCENT BODY FREQUENCY IN AUTOPSY SERVICE WORKERS EXPOSED TO FORMALDEHYDE

    EPA Science Inventory

    The ability of a battery of genetic monitoring tests to detect occupational formaldehyde exposure in a population of a hospital autopsy service workers was investigated. Eleven exposed individuals and 11 matched controls were evaluated for sperm count, abnormal sperm morphology a...

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  19. What Killed This Bank? Financial Autopsy as an Experiential Learning Tool

    ERIC Educational Resources Information Center

    Hays, Fred H.; DeLurgio, Stephen A.

    2010-01-01

    Finance students today live in the midst of an enormous financial crisis. Institutions both large and small are failing or being rescued through government intervention. This environment presents a host of learning opportunities for instructors as well as students. This paper discusses financial autopsies as a form of experiential learning…

  20. Amended forensic autopsy legal procedures in Turkey during integration with the European Union (EU).

    PubMed

    Celbis, Osman; Aydin, N Engin; Kok, Ahmet Nezih

    2006-12-01

    European Union (EU) is expanding its territories, and Turkey has been making adaptive changes in many aspects for an integration with EU. In this regard, amendments on forensic autopsy procedures have been effective from June 1, 2005. This article delineates these changes, emphasizing the differences between the previous and the current procedures. PMID:17133036

  1. Search and removal of radioactive seeds: another application of postmortem computed tomography prior to autopsy.

    PubMed

    Makino, Yohsuke; Itoda, Nozomi; Ikegaya, Hiroshi; Tanaka, Naoko; Kinoshita, Hiroshi; Motomura, Ayumi; Uno, Takashi; Iwase, Hirotaro

    2016-09-01

    We herein introduce 3 cases illustrating a new application for pre-autopsy postmortem computed tomography (PMCT). In all 3 cases, there was insufficient background information about the victims provided to the forensic pathologists' department. PMCT showed metallic particles in the prostate gland, an indication of metallic seeds containing radioactive isotopes. In 2 of 3 cases, migrated seeds were also detected by CT imaging in the lungs and the heart. Also in 2 of 3 cases, authorities reinvestigated the victim's history before autopsy was completed, which resulted in following appropriate procedure for dealing with the seeds. Although all 3 cadavers were cremated after autopsy, the International Commission on Radiological Protection (ICRP) discourages cremation for deaths soon after radioactive seeds implantation to prevent air pollution by radioactive isotopes in the ash. Our opinion from the present cases is that pre-autopsy PMCT can be recommended for use by forensic pathologists and guidelines for investigating deaths after permanent brachytherapy should include how to deal with cadavers when medical history is limited. PMID:27334769

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

    ERIC Educational Resources Information Center

    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…

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

    EPA Science Inventory

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

  4. Medical Malpractice in Wuhan, China: A 10-Year Autopsy-Based Single-Center Study.

    PubMed

    He, Fanggang; Li, Liliang; Bynum, Jennifer; Meng, Xiangzhi; Yan, Ping; Li, Ling; Liu, Liang

    2015-11-01

    Medical disputes in China are historically poorly documented. In particular, autopsy-based evaluation and its impact on medical malpractice claims remain largely unstudied. This study aims to document autopsy findings and medical malpractice in one of the largest cities of China, Wuhan, located in Hubei Province. A total of 519 autopsies were performed by the Department of Forensic Medicine, Wuhan University School of Medicine, Wuhan, China, over a 10-year period between 2004 and 2013. Of these cases, 190 (36.6%) were associated with medical malpractice claims. Joint evaluation by forensic pathologists and clinicians confirmed that 97 (51.1%) of the 190 claims were approved medical malpractice cases. The percentage of approved malpractice cases increased with patient age and varied according to medical setting, physician specialty, and organ system. The clinico-pathological diagnostic discrepancy was significantly different among various physician specialties (P = 0.031) and organ systems (P = 0.000). Of those cases involved in malpractice claims, aortic dissection, coronary heart disease, and acute respiratory infection were most common. Association between incorrect diagnosis and malpractice was significant (P = 0.001). This is the first report on China's medical malpractice and findings at autopsy which reflects the current state of health care services in one of the biggest cities in China. PMID:26559306

  5. The Next Generation of Psychological Autopsy Studies: Part I. Interview Content

    ERIC Educational Resources Information Center

    Conner, Kenneth R.; Beautrais, Annette L.; Brent, David A.; Conwell, Yeates; Phillips, Michael R.; Schneider, Barbara

    2011-01-01

    The psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of decedents. The methodological challenges that need to be addressed when determining the content of these research interviews…

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

    PubMed

    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

  7. Validation of Verbal Autopsy Tool for Ascertaining the Causes of Stillbirth

    PubMed Central

    Nausheen, Sidrah; Soofi, Sajid B.; Sadiq, Kamran; Habib, Atif; Turab, Ali; Memon, Zahid; Khan, M. Imran; Suhag, Zamir; Bhatti, Zaid; Ahmed, Imran; Bahl, Rajiv; Bhutta, Shireen; Bhutta, Zulfiqar A.

    2013-01-01

    Objective To assess performance of the WHO revised verbal autopsy tool for ascertaining the causes of still birth in comparison with reference standard cause of death ascertained by standardized clinical and supportive data. Methods All stillbirths at a tertiary hospital in Karachi, Pakistan were prospectively recruited into study from August 2006- February 2008. The reference standard cause of death was established by two senior obstetricians within 48 hours using the ICD coding system. Verbal autopsy interviews using modified WHO tool were conducted by trained health workers within 2- 6 weeks of still birth and the cause of death was assigned by second panel of obstetricians. The performance was assessed in terms of sensitivity, specificity and Kappa. Results There were 204 still births. Of these, 80.8% of antepartum and 50.5% of intrapartum deaths were correctly diagnosed by verbal autopsy. Sensitivity of verbal autopsy was highest 68.4%, (95%CI: 46-84.6) for congenital malformation followed by obstetric complication 57.6%, (95%CI: 25-84.2). The specificity for all major causes was greater than 90%. The level of agreement was high (kappa=0.72) for anomalies and moderate (k=0.4) for all major causes of still birth, except asphyxia. Conclusion Our results suggest that verbal autopsy has reasonable validity in identifying and discriminating between causes of stillbirth in Pakistan. On the basis of these findings, we feel it has a place in resource constrained areas to inform strategic planning and mobilization of resources to attain Millennium Development Goals. PMID:24130814

  8. Undetected patricide: Inaccuracy of cause of death determination without an autopsy.

    PubMed

    Campobasso, Carlo P; Laviola, Domenica; Grattagliano, Ignazio; Strada, Luigi; Dell'Erba, Alessandro S

    2015-08-01

    Patricide (killing the father) is uncommon form of homicide. Usually the assaults occur at home in the absence of witnesses and adult sons are frequently involved. Homicides in a domestic context usually do not tend to recurrence, because the motivation for the crime ends with the death of the parent. However, this is not what was observed in the present case study dealing with the death of a 70 years old white man originally misclassified as accident and discovered three years later only after an additional homicide in a family context of a 60 years old white lady. Multiple stab wounds to the neck and thorax were misinterpreted at the external male body examination as blunt trauma falling down stairs. No forensic autopsy was requested and no comparison of medical findings with the results from the death scene, such as a bloodstain analysis was performed by the police officers nor required by the judicial authority. This was quite surprising because an additional but preliminary post-mortem external examination performed by a general practitioner on the male body already raised the suspicion that the external lesions were stab wounds thus requiring a forensic autopsy. Only the exhumation of the elderly body, performed years later, confirmed the diagnostic hypothesis raised by the first physician. The present case is quite representative of a death investigation not run professionally and performed by individuals with no specific training where most of the medico-legal investigations (especially for traumatic and violent deaths) are restricted to an external body examination without subsequent autopsy. Although misinterpretation of external lesions is inevitable and significant discrepancies between external body examination and forensic autopsy are not rare, in the case of contradictory results of post-mortem external examination or unclear/suspicious cause and manner of death, investigation should proceed necessarily with a forensic autopsy. PMID:26165662

  9. How Much Does a Verbal Autopsy Based Mortality Surveillance System Cost in Rural India?

    PubMed Central

    Joshi, Rohina; Praveen, Deversetty; Jan, Stephen; Raju, Krishnam; Maulik, Pallab; Jha, Vivekanand; Lopez, Alan D.

    2015-01-01

    Objective This paper aims to determine the cost of establishing and sustaining a verbal-autopsy based mortality surveillance system in rural India. Materials and Methods Deaths occurring in 45 villages (population 185,629) were documented over a 4-year period from 2003–2007 by 45 non-physician healthcare workers (NPHWs) trained in data collection using a verbal autopsy tool. Causes of death were assigned by 2 physicians for the first year and by one physician for the subsequent years. Costs were calculated for training of interviewers and physicians, data collection, verbal autopsy analysis, project management and infrastructure. Costs were divided by the number of deaths and the population covered in the year. Results Verbal-autopsies were completed for 96.7% (5786) of all deaths (5895) recorded. The annual cost in year 1 was INR 1,133,491 (USD 24,943) and the total cost per death was INR 757 (USD 16.66). These costs included training of NPHWs and physician reviewers Rs 67,025 (USD 1474), data collection INR 248,400 (USD 5466), dual physician review for cause of death assignment INR 375,000 (USD 8252), and project management INR 341,724 (USD 7520). The average annual cost to run the system each year was INR 822,717 (USD18104) and the cost per death was INR 549 (USD 12) for the next 3 years. Costs were reduced by using single physician review and shortened re-training sessions. The annual cost of running a surveillance system was INR 900,410 (USD 19814). Discussion This study provides detailed empirical evidence of the costs involved in running a mortality surveillance site using verbal-autopsy. PMID:25955389

  10. Medical malpractice as reflected by the forensic evaluation of 4450 autopsies.

    PubMed

    Madea, Burkhard; Preuss, Johanna

    2009-09-10

    A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases. PMID:19524380

  11. Let's talk about death: data collection for verbal autopsies in a demographic and health surveillance site in Malaysia

    PubMed Central

    Allotey, Pascale A.; Reidpath, Daniel D.; Evans, Natalie C.; Devarajan, Nirmala; Rajagobal, Kanason; Bachok, Ruhaida; Komahan, Kridaraan

    2015-01-01

    Background Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. Methods A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. Results Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings. PMID:26140728

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

    PubMed Central

    Swain, Rajanikanta; Mallick, Saumyaranjan; Behera, C; Murty, O P

    2013-01-01

    Many times at autopsy, on the basis of colour change of the stomach and intestinal mucosa, the forensic pathologist is able to suspect a particular nature of poisoning which leads to conclusive investigation of the case. An intense bluish discolouration of the gastric mucosa owing to capsule shell instead of the content is rarely encountered at autopsy. We report a case of fatal dextropropoxyphene poisoning, where gastric and small intestinal mucosa showed bluish discolouration owing to the gelatine capsule of the drug. Other causes of bluish discolouration of gastrointestinal tract mucosa at autopsy are also discussed. PMID:23606385

  13. The First Survey of Forensically Important Entomofauna Collected from Medicolegal Autopsies in South Korea

    PubMed Central

    Shin, Sang Eon; Lee, Hyun Ju; Park, Ji Hye; Ko, Kwang Soo; Kim, Yu-Hoon; Kim, Kyung Ryoul; Park, Seong Hwan

    2015-01-01

    Forensic entomology applies insect evidence to legal problems such as the estimation of minimum postmortem interval (mPMI). For this purpose, knowledge of the insect fauna that are attracted to human cadavers in each geographic region is a prerequisite. Despite many studies investigating the insect fauna attracted to meat, there has been no survey of the entomofauna on human cadavers in the East Asian temperate climate zone, particularly in Korea. Therefore, this study reports the entomofauna collected from medicolegal autopsies in northeastern Seoul and its suburbs. Insect samples were collected from 35 medicolegal autopsies in 2010, 2011, and 2013. Molecular and morphological methods were utilized for taxonomic identification. Among 1398 individual samples belonging to 3 orders, 13 families, 18 genera, and 32 species, the dominant family and species were Calliphoridae and Lucilia sericata, respectively. Despite its limited scale, this study provides a snapshot of the general entomofauna that are attracted to human cadavers in this region. PMID:26185759

  14. Antenatal manifestations of inborn errors of metabolism: autopsy findings suggestive of a metabolic disorder.

    PubMed

    Collardeau-Frachon, Sophie; Cordier, Marie-Pierre; Rossi, Massimiliano; Guibaud, Laurent; Vianey-Saban, Christine

    2016-09-01

    This review highlights the importance of performing an autopsy when faced with fetal abortion or termination of pregnancy with suspicion of an inborn error of metabolism. Radiological, macroscopic and microscopic features found at autopsy as well as placental anomalies that can suggest such a diagnosis are detailed. The following metabolic disorders encountered in fetuses are discussed: lysosomal storage diseases, peroxisomal disorders, cholesterol synthesis disorders, congenital disorders of glycosylation, glycogenosis type IV, mitochondrial respiratory chain disorders, transaldolase deficiency, generalized arterial calcification of infancy, hypophosphatasia, arylsulfatase E deficiency, inborn errors of serine metabolism, asparagine synthetase deficiency, hyperphenylalaninemia, glutaric aciduria type I, non-ketotic hyperglycinemia, pyruvate dehydrogenase deficiency, pyruvate carboxylase deficiency, glutamine synthase deficiency, sulfite oxidase and molybdenum cofactor deficiency. PMID:27106218

  15. Pulmonary embolism after arterial chemoembolization for hepatocellular carcinoma: An autopsy case report

    PubMed Central

    Hatamaru, Keiichi; Azuma, Shunjiro; Akamatsu, Takuji; Seta, Takeshi; Urai, Shunji; Uenoyama, Yoshito; Yamashita, Yukitaka; Ono, Kazuo

    2015-01-01

    We report an extremely rare case of pulmonary lipiodol embolism with acute respiratory distress syndrome (ARDS) after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). A 77-year-old man who was diagnosed with a huge HCC was admitted for TACE. Immediately after the procedure, this patient experienced severe dyspnea. We suspected that his symptoms were associated with a pulmonary lipiodol embolism after TACE, and we began intensive treatment. However, his condition did not improve, and he died on the following day. A subsequent autopsy revealed that the cause of death was ARDS due to pulmonary lipiodol embolism. No cases have been previously reported for which an autopsy was performed to explain the most probable mechanism of pulmonary lipiodol embolism; thus, ours is the first report for such a rare case. PMID:25632211

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

    PubMed

    Slot, Liselott; Larsen, Peter K; Lynnerup, Niels

    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. PMID:24117866

  17. ABSENCE OF MUTAGENICITY IN THE URINE OF AUTOPSY SERVICE WORKERS EXPOSED TO FORMALDEHYDE: FACTORS INFLUENCING MUTAGENICITY TESTING OF URINE

    EPA Science Inventory

    The study examined the effect of exposure to autopsy workers to formaldehyde using urinary mutagenicity testing with Salmonella typhimurium. A matched control group was also studied. Additional studies including the recovery of histidine from urine samples, the determination of h...

  18. Measuring Maternal Mortality: Three Case Studies Using Verbal Autopsy with Different Platforms

    PubMed Central

    2015-01-01

    Background Accurate measurement of maternal mortality is needed to develop a greater understanding of the scale of the problem, to increase effectiveness of program planning and targeting, and to track progress. In the absence of good quality vital statistics, interim methods are used to measure maternal mortality. The purpose of this study is to document experience with three community-based interim methods that measure maternal mortality using verbal autopsy. Methods This study uses a post-census mortality survey, a sample vital registration with verbal autopsy, and a large-scale household survey to summarize the measures of maternal mortality obtained from these three platforms, compares and contrasts the different methodologies employed, and evaluates strengths and weaknesses of each approach. Included is also a discussion of issues related to death identification and classification, estimating maternal mortality ratios and rates, sample sizes and periodicity of estimates, data quality, and cost. Results The sample sizes vary considerably between the three data sources and the number of maternal deaths identified through each platform was small. The proportion of deaths to women of reproductive age that are maternal deaths ranged from 8.8% to 17.3%. The maternal mortality rate was estimable using two of the platforms while obtaining an estimate of the maternal mortality ratio was only possible using one of the platforms. The percentage of maternal deaths due to direct obstetric causes ranged from 45.2% to 80.4%. Conclusions This study documents experiences applying standard verbal autopsy methods to estimate maternal mortality and confirms that verbal autopsy is a feasible method for collecting maternal mortality data. None of these interim methods are likely to be suitable for detecting short term changes in mortality due to prohibitive sample size requirements, and thus, comprehensive and continuous civil registration systems to provide high quality vital

  19. Invasive fungal disease in university hospital: a PCR-based study of autopsy cases

    PubMed Central

    Ruangritchankul, Komkrit; Chindamporn, Ariya; Worasilchai, Navaporn; Poumsuk, Ubon; Keelawat, Somboon; Bychkov, Andrey

    2015-01-01

    Invasive fungal disease (IFD) has high mortality rate, especially in the growing population of immunocompromised patients. In spite of introduction of novel diagnostic approaches, the intravital recognition of IFD is challenging. Autopsy studies remain a key tool for assessment of epidemiology of visceral mycoses. We aimed to determine species distribution and trends of IFD over the last 10 years in unselected autopsy series from a large university hospital. Forty-five cases of visceral mycoses, confirmed by histopathology and panfungal PCR, were found in 587 consecutive autopsies. Major underlying diseases were diabetes mellitus (20%), hematologic malignancies (15.6%) and systemic lupus erythematosus (15.6%). There was a high risk for disseminated IFD in immunocompromised patients stayed in the hospital over 1 month with a fever longer than 3 weeks. The most common fungi were Aspergillus spp. (58%), Candida spp. (16%), Mucorales (14%) and Fusarium spp. (10%). We found significant increase in Aspergillus flavus (P = 0.04) and Mucorales (P < 0.01) infections over the last 5 years. Concordance rate between histopathology and panfungal PCR was 89.5% to the genus level. All 6 cases of fusariomycosis were misinterpreted as aspergillosis by histology alone. The precise species identification, necessary for targeted antifungal treatment, was rendered only by the molecular technique. Panfungal PCR showed high performance on formalin-fixed paraffin-embedded specimens, providing important epidemiological data in retrospective autopsy series. Rapid detection of fungi by panfungal PCR assay has high potential for intravital diagnostics of IFD in surgical and biopsy specimens. PMID:26823814

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

    PubMed

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

    2002-09-01

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

  1. Pulmonary Histopathologic Abnormalities and Predictor Variables in Autopsies of Burned Pediatric Patients

    PubMed Central

    Sousse, Linda E.; Herndon, David N.; Andersen, Clark R.; Zovath, Andrew; Finnerty, Celeste C.; Mlcak, Ronald P.; Cox, Robert A.; Traber, Daniel L.; Hawkins, Hal K.

    2014-01-01

    Pulmonary abnormalities occur in 30–80% of fatalities after burn injury. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. METHODS Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002–2012 (n=43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. RESULTS Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p<0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p<0.01). The scores for protein were significantly higher in cases with longer survival after burn (p<0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p<0.01), and in cases with the presence of inhalation injury (p<0.01). CONCLUSIONS Histological findings associated with Diffuse Alveolar Damage (DAD), which is the pathological correlate of the Acute Respiratory Distress Syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury. PMID:25445004

  2. Pathological and radiological correlation in an autopsy case of combined pulmonary fibrosis and emphysema

    PubMed Central

    Karata, Hiroki; Tanaka, Tomonori; Egashira, Ryoko; Tabata, Kazuhiro; Otani, Kyoko; Hayashi, Ryuji; Hori, Takashi; Fukuoka, Junya

    2015-01-01

    We report an educational autopsy case of combined pulmonary fibrosis and emphysema. Radiological patterns of the upper lung were considered as mostly emphysema, but pathological observation revealed significant interstitial fibrosis of usual interstitial pneumonia as a major pathology. The patient eventually developed acute exacerbation of background interstitial pneumonia. Careful radiological and pathological correlation of the current case indicates that regions with distal acinar emphysema on computed tomography image may possess histologically marked dense fibrosis of lethal interstitial pneumonia. PMID:26185436

  3. [Massive cardiac lipomatosis, an autopsy finding in a patient with sudden death].

    PubMed

    Zamarrón-de Lucas, Ester; García-Fernández, Eugenia; Carpio, Carlos; Alcolea, Sergio; Martínez-Abad, Yolanda; Álvarez-Sala, Rodolfo

    2016-06-17

    The fat replacement of myocardial cells is a degenerative process that usually affects the right ventricle and is found in 50% of the elderly. The problem arises when this degeneration occurs to a massive degree, a differential diagnosis with other pathologies being necessary. We present the case of a patient who died suddenly and a massive cardiac lipomatosis was found on autopsy, as the only explanation of the outcome. PMID:27143526

  4. Syphilitic Aortitis: Autopsy Experience at the Ottawa General Hospital Since 1950

    PubMed Central

    Heggtveit, H. Alexander

    1965-01-01

    Twenty-six cases of syphilitic aortitis were found among 4173 autopsies performed at the Ottawa General Hospital since 1950. Although 10 aortic aneurysms, nine instances of coronary ostial stenosis and five examples of aortic incompetence were present in 20 cases, a clinical diagnosis of syphilitic aortitis had been established in only two patients. It is paradoxical that the clinical diagnosis of syphilitic aortitis is becoming less accurate as surgical techniques for the correction of its complications are being constantly improved. PMID:14282945

  5. Two forensic autopsy cases of death from unexpected lesions of the pituitary gland.

    PubMed

    Suzuki, Hideto; Hayashi, Kino; Fukunaga, Tatsushige

    2014-01-01

    Herein, we report the findings of 2 forensic autopsy cases, in which unexpected pituitary lesions were the underlying cause of death. Case 1: A 56-year-old woman was found dead at her home during a cold winter spell. Macroscopic autopsy findings included a difference in the color of blood that filled her left and right cardiac chambers (deep red and dark red, respectively), collapse of both lungs, atrophy of the thyroid gland, and a large tumor arising from the sella turcica. Microscopic examination revealed a pituitary adenoma along with extensive bleeding. The cause of death was considered to be hypothermia, resulting from dysregulation of thermogenesis due to the pituitary adenoma. Case 2: An 86-year-old man with a history of pollakiuria was found dead in a bathtub, with his face and chest submerged in bathwater and his legs positioned outside the bathtub. The macroscopic findings of the autopsy included hyper-inflated lungs, fluid collection in the thoracic cavity, and aspiration of gastric contents in the bronchi. The atherosclerotic changes of the man's coronary and cerebral arteries were considered mild for his age. Microscopic examination showed a marked infiltration of lymphocytes and plasma cells in the posterior pituitary gland, as well as in the liver, pancreas, and submandibular gland. Considering the results of the autopsy and the findings from the investigation conducted at the death scene, we concluded that the man probably lost consciousness following a neurally mediated syncope, which was induced by diabetes insipidus (lymphocytic hypophysitis). After losing consciousness, the man likely fell in the filled bathtub and then drowned. These 2 cases highlight the need for a thorough post-mortem investigation, including a microscopic examination of the pituitary gland. In addition, forensic pathologists should carefully study the pituitary gland in cases where the cause of death is thought to be related to dysfunction of thermoregulation or

  6. Perianesthetic Mortality in Domestic Animals: A Retrospective Study of Postmortem Lesions and Review of Autopsy Procedures.

    PubMed

    DeLay, J

    2016-09-01

    Autopsy of animals that die in the perianesthetic period allows identification of anesthetic and surgical complications as well as preexisting disease conditions that may have contributed to mortality. In most studies to date investigating perianesthetic mortality in animals, inclusion of autopsy data is very limited. This retrospective study evaluated autopsy findings in 221 cases of perianesthetic death submitted to a veterinary diagnostic laboratory from primary care and referral hospitals. Canine (n = 105; 48%) and feline (n = 90; 41%) cases predominated in the study, involving elective (71%) and emergency (19%) procedures. The clinical history provided to the pathologist was considered incomplete in 42 of 221 cases (19%), but this history was considered essential for evaluating the circumstances of perianesthetic death. Disease had been recognized clinically in 69 of 221 animals (31%). Death occurred in the premedication or sedation (n = 19; 9%), induction (n = 22; 11%), or maintenance (n = 73; 35%) phases or in the 24 hours postanesthesia (n = 93 animals; 45%). Lesions indicative of significant natural disease were present in 130 of 221 animals (59%), mainly involving the heart, upper respiratory tract, or lungs. Surgical or anesthesia-associated complications were identified in 10 of 221 cases (5%). No lesions were evident in 80 of 221 animals (36%), the majority of which were young, healthy, and undergoing elective surgical procedures. Lesions resulting from cardiopulmonary resuscitation were identified in 75 of 221 animals (34%). Investigation of perianesthetic death cases should be done with knowledge of prior clinical findings and antemortem surgical and medical procedures; the autopsy should particularly focus on the cardiovascular and respiratory system, including techniques to identify pneumothorax and venous air embolism. PMID:27371539

  7. Café coronary syndrome-fatal choking on food: an autopsy approach.

    PubMed

    Wick, Regula; Gilbert, John D; Byard, Roger W

    2006-04-01

    To examine the characteristic features of fatal food asphyxia and to develop an autopsy approach to such cases a retrospective study of autopsy files was undertaken at Forensic Science SA (Adelaide, Australia) over a 10 year period from 1993 to 2002 for all cases of food asphyxia/café coronary syndrome. Forty-four cases were identified (M;F=21:23), with one infant (11 mths) and 43 adults (30-96 yrs; mean 68.9 yrs), with a preponderance of victims (57%) aged between 71 and 90 yrs. Deaths occurred in nursing homes (N=22) cases, at home (N=11) and in restaurants (N=4). Twenty-seven of the victims (61%) had histories of neurological or psychiatric disorders such as dementia (N=8), schizophrenia (N=6), Alzheimer disease (N=4), atherosclerotic cerebrovascular disease (N=4), mental impairment (N=2), multiple sclerosis (N=1), Parkinson disease (N=1) and obsessive-compulsive disorder (N=1). Twenty-seven cases (61%) were described as either edentulous or having significant numbers of teeth missing. Toxicological evaluation of blood revealed alcohol and a variety of psychotropic prescription medications in 19 cases. Sudden collapse during or shortly after a meal should always raise the possibility of café coronary and the autopsy examination should not only attempt to demonstrate airway occlusion by a bolus of food, but also to identify or exclude underlying neurological disease. Such cases may raise issues concerning adequacy of care and appropriateness of medication. The diagnosis of café coronary syndrome can only be made with confidence after the clinical history and circumstances of death have been clearly established, impacted material has been demonstrated in the airway at autopsy (or recorded by those attempting resuscitation), risk factors have been identified and other possible causes of death have been excluded. PMID:16356749

  8. An autopsy case related to a terrorist attack using a ball-bearing bomb.

    PubMed

    Takamiya, Masataka; Biwasaka, Hitoshi; Niitsu, Hisae; Saigusa, Kiyoshi; Aoki, Yasuhiro

    2009-03-01

    We encountered an autopsy case related to a terrorist attack using a ball-bearing bomb. The decedent was a 51-year-old male without significant medical histories. During dinner in a restaurant, the perpetrator suddenly exploded a ball-bearing bomb, the blast from which blew the victim off his chair. The victim was found to be unresponsive, and pronounced dead. X-ray photographs taken before autopsy revealed six spherical shadows. Three penetrating wounds in the head, one in the neck and chest, and two in the left upper arm were observed in vivo. Six projectiles recovered from the body were identified as ball-bearings, one of which traveled through the midbrain, diencephalon, and left temporal lobe. Although blast injuries and penetrating wounds are often combined in bomb attack victims, penetrating brain injury would be the cause of death in this case. Lethal injuries to major organs can thus occur even though the destructive force of a ball-bearing bomb is weak. X-ray films were informative for detecting the ball-bearings in this case, suggesting that autopsy imaging is essential in cases of terrorism victims. PMID:18783977

  9. Characteristics of chromate workers' cancers, chromium lung deposition and precancerous bronchial lesions: an autopsy study.

    PubMed Central

    Ishikawa, Y.; Nakagawa, K.; Satoh, Y.; Kitagawa, T.; Sugano, H.; Hirano, T.; Tsuchiya, E.

    1994-01-01

    The characteristics of lung cancers induced by inhaled chromate were studied in 13 consecutive autopsies on male ex-chromate workers. In addition to histopathology, we examined: (1) the relationship between the occurrence of lung cancer and the amount of chromium (Cr) deposited in the lung as determined by atomic absorptiometry and (2) the chronological changes in five precancerous lung lesions followed by bronchoscopy till death. Twenty-one cancers were identified, including 16 lung tumours observed either during follow-up or at autopsy. Of these 16 tumours, 13 were found in six subjects, implying a high frequency of multiple cancers. Eleven (69%) out of the 16 tumours were of squamous cell type (including carcinoma in situ), this being twice as frequent as in age-matched controls. A further characteristic was predominance in the central part of lung (69%). The lung Cr burden was very much higher [40-15,800 micrograms g-1 (dry)] in patients with lung tumours than in those without (8-28 micrograms g-1). Five of the precancerous lesions followed by bronchoscopy originated at bronchial bifurcations. Four of these cases showed a return to normal histology at autopsy even without therapy, and the other did not progress. Images Figure 2 PMID:8018529

  10. Epidemiology of invasive fungal diseases on the basis of autopsy reports.

    PubMed

    Dignani, María Cecilia

    2014-01-01

    Invasive fungal diseases (IFDs) are a major cause of morbidity and mortality among immunocompromised patients and cost to health services. They are difficult to prevent, diagnose, and treat. This difficulty in diagnosis leads us to treat them empirically by using several tools, including epidemiological data, non-culture methods and images. Most of the available epidemiological information may not be accurate because we are dealing with a disease that only has an estimated 50% chance of being diagnosed before death. Therefore, autopsy reports become a valuable tool, not only to define the real epidemiology, but also to address the trend in pre-mortem diagnosis, which is the best marker available to prove the efficiency of the research in IFD. This article reviews and analyzes the data on IFD obtained from 11 single-center, multi-center and nationwide autopsy reports published between 2008 and 2013, and also discusses the issues we need to address in order to improve the quality of the epidemiological data on invasive fungal disease obtained from autopsy reports. PMID:25343038

  11. Epidemiology of invasive fungal diseases on the basis of autopsy reports

    PubMed Central

    2014-01-01

    Invasive fungal diseases (IFDs) are a major cause of morbidity and mortality among immunocompromised patients and cost to health services. They are difficult to prevent, diagnose, and treat. This difficulty in diagnosis leads us to treat them empirically by using several tools, including epidemiological data, non-culture methods and images. Most of the available epidemiological information may not be accurate because we are dealing with a disease that only has an estimated 50% chance of being diagnosed before death. Therefore, autopsy reports become a valuable tool, not only to define the real epidemiology, but also to address the trend in pre-mortem diagnosis, which is the best marker available to prove the efficiency of the research in IFD. This article reviews and analyzes the data on IFD obtained from 11 single-center, multi-center and nationwide autopsy reports published between 2008 and 2013, and also discusses the issues we need to address in order to improve the quality of the epidemiological data on invasive fungal disease obtained from autopsy reports. PMID:25343038

  12. Beethoven's renal disease based on his autopsy: a case of papillary necrosis.

    PubMed

    Schwarz, A

    1993-06-01

    The autopsy report of Ludwig van Beethoven written by Dr Johann Wagner in 1827 reveals that he had renal calculi that had not been diagnosed during his lifetime, together with perirenal fibrosis. The most comprehensive interpretation of this autopsy finding is that the regular calcareous deposits in every one of his renal calices represented calcified necrotic papillae. Severe urinary obstruction or diabetes as possible causes of papillary necrosis were not present. Analgesic abuse because of headaches, back pain, and attacks of rheumatism or gout may be presumed on the basis of Beethoven's uncontrolled way of taking medication. Salicin, a commonly used analgesic substance of that time (dried and powdered willow bark), is able to cause papillary necrosis. Perirenal fibrosis may be due to chronic infection or drug intake. Beethoven's other well-known diseases are deafness caused by otosclerosis of the inner ear, relapsing attacks of diarrhea as the symptoms of irritable bowel syndrome, and liver cirrhosis following viral hepatitis and chronic alcohol consumption. Liver cirrhosis also may cause papillary necrosis. In Beethoven's case, renal papillary necrosis was most probably the consequence of analgesic abuse together with decompensated liver cirrhosis. The autopsy report of Beethoven is the first case of papillary necrosis recorded in the literature. PMID:8503419

  13. Widespread inflammation in CLIPPERS syndrome indicated by autopsy and ultra-high-field 7T MRI

    PubMed Central

    Blaabjerg, Morten; Ruprecht, Klemens; Sinnecker, Tim; Kondziella, Daniel; Niendorf, Thoralf; Kerrn-Jespersen, Bjørg Morell; Lindelof, Mette; Lassmann, Hans; Kristensen, Bjarne Winther; Paul, Friedemann

    2016-01-01

    Objective: To examine if there is widespread inflammation in the brain of patients with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome by using histology and ultra-high-field MRI at 7.0T. Methods: We performed a detailed neuropathologic examination in 4 cases, including 1 autopsy case, and studied 2 additional patients by MRI at 7.0T to examine (1) extension of inflammation to areas appearing normal on 3.0T MRI, (2) potential advantages of 7.0T MRI compared to 3.0T MRI in reflecting widespread inflammation, perivascular pathology, and axonal damage, and (3) the possibility of lymphoma. Results: In the autopsy case, perivascular inflammation dominated by CD4+ T cells was not only detected in the brainstem and cerebellum but also in brain areas with normal appearance on 3.0T MRI, including supratentorial regions and cranial nerve roots. There was no evidence of lymphoma in any of the 4 patients. The 7.0T MRI in clinical remission also revealed supratentorial lesions and perivascular pathology in vivo with contrast-enhancing lesions centered around a small venous vessel. Ultra-high-field MRI at 7.0T disclosed prominent T1 hypointensities in the brainstem, which were not seen on 3.0T MRI. This corresponded to neuropathologic detection of axonal injury in the autopsy case. Conclusion: Our findings suggest more widespread perivascular inflammation and postinflammatory axonal injury in patients with CLIPPERS. PMID:27144217

  14. Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series.

    PubMed

    Brinkerhoff, Brian T; Houghton, Donald C; Troxell, Megan L

    2016-06-01

    Renal injury in hematopoietic cell transplant recipients may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease, and can involve glomerular, tubulointerstitial, and vascular structures. We reviewed renal pathology from 67 patients at a single institution (2009-2014), including 14 patients with biopsy for clinical dysfunction, 6 patients with surgical kidney resection for other causes, and 47 autopsy patients. Kidney specimens frequently contained multiple histopathologic abnormalities. Thrombotic microangiopathy, membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis were the most common glomerular findings. Pathologies not previously reported in the hematopoietic cell transplant setting included collapsing glomerulopathy, antiglomerular basement membrane disease, fibrillary glomerulonephritis, and in the case of two surgical resections distinctive cellular segmental glomerular lesions that defied classification. Kidney specimens frequently demonstrated acute tubular injury, interstitial fibrosis, arteriolar hyaline, and arteriosclerosis. Other kidney findings at autopsy included leukemia and amyloid (both recurrent), diabetic nephropathy, bacterial infection, fungal invasion, and silver deposition along glomerular and tubular basement membranes. Also in the autopsy cohort, C4d immunohistochemistry demonstrated unexpected membranous nephropathy in two patients, yet C4d also colocalized with arteriolar hyaline. This retrospective hematopoietic cell transplant cohort illustrates multifaceted renal injury in patients with renal dysfunction, as well as in patients without clinically recognized kidney injury. PMID:27015134

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

    PubMed Central

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

    2001-01-01

    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. PMID:11584727

  16. Studying Suicide with Psychological Autopsy: Social and Cultural Feasibilities of the Methodology in China

    PubMed Central

    Zhang, Jie; Wieczorek, William F.; Jiang, Chao; Zhou, Li; Jia, Shuhua; Sun, Yueji; Jin, Shenghua; Conwell, Yeates

    2009-01-01

    As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides. PMID:12501962

  17. An Autopsy Case of Rapidly Progressing Spindle Cell Carcinoma of the Lung Accompanied with Intratumor Hemorrhage

    PubMed Central

    Kida, Jun-ichiro; Kanaji, Nobuhiro; Kishi, Sosuke; Imaida, Katsumi; Bandoh, Shuji

    2015-01-01

    Patient: Male, 74 Final Diagnosis: Spindle cell carcinoma of the lung Symptoms: — Medication: Pemetrexed • carboplatin Clinical Procedure: Biopsy and autopsy Specialty: Oncology Objective: Rare disease Background: Spindle cell carcinoma (SPCC) of the lung is a subset of sarcomatoid carcinoma. Its clinical features are unclear because of its rarity. Here, we report an autopsy case of SPCC and review CT findings and chemotherapeutic regimens based on previous reports of this disease. To our knowledge, this is the first reported case of pemetrexed used to treat SPCC. Case Report: A 74-year-old Japanese male presented with dyspnea and contrast-enhanced computed tomography (CT) showed abundant left pleural effusion and a mass in lower lobe of the left lung. By the tumor biopsy, he was diagnosed for SPCC of the lung, cT3N0M1a, stage IV. The tumor was resistant to chemotherapy with carboplatin and pemetrexed, and rapidly progressed. Autopsy revealed abundant hemorrhage within the tumor, which apparently reflects a low-density area in CT. Conclusions: Present case and the accumulation of cases indicate that low-density areas in CT and rapid tumor progression may be common SPCC findings. PMID:26558362

  18. Validating physician-certified verbal autopsy and probabilistic modeling (InterVA) approaches to verbal autopsy interpretation using hospital causes of adult deaths

    PubMed Central

    2011-01-01

    Background The most common method for determining cause of death is certification by physicians based either on available medical records, or where such data are not available, through verbal autopsy (VA). The physician-certification approach is costly and inconvenient; however, recent work shows the potential of a computer-based probabilistic model (InterVA) to interpret verbal autopsy data in a more convenient, consistent, and rapid way. In this study we validate separately both physician-certified verbal autopsy (PCVA) and the InterVA probabilistic model against hospital cause of death (HCOD) in adults dying in a district hospital on the coast of Kenya. Methods Between March 2007 and June 2010, VA interviews were conducted for 145 adult deaths that occurred at Kilifi District Hospital. The VA data were reviewed by a physician and the cause of death established. A range of indicators (including age, gender, physical signs and symptoms, pregnancy status, medical history, and the circumstances of death) from the VA forms were included in the InterVA for interpretation. Cause-specific mortality fractions (CSMF), Cohen's kappa (κ) statistic, receiver operating characteristic (ROC) curves, sensitivity, specificity, and positive predictive values were applied to compare agreement between PCVA, InterVA, and HCOD. Results HCOD, InterVA, and PCVA yielded the same top five underlying causes of adult deaths. The InterVA overestimated tuberculosis as a cause of death compared to the HCOD. On the other hand, PCVA overestimated diabetes. Overall, CSMF for the five major cause groups by the InterVA, PCVA, and HCOD were 70%, 65%, and 60%, respectively. PCVA versus HCOD yielded a higher kappa value (κ = 0.52, 95% confidence interval [CI]: 0.48, 0.54) than the InterVA versus HCOD which yielded a kappa (κ) value of 0.32 (95% CI: 0.30, 0.38). Overall, (κ) agreement across the three methods was 0.41 (95% CI: 0.37, 0.48). The areas under the ROC curves were 0.82 for InterVA and 0

  19. Violence against women: A series of autopsy studies from Istanbul, Turkey.

    PubMed

    Unal, Esra Ozgun; Koc, Sermet; Unal, Volkan; Akcan, Ramazan; Javan, Gulnaz T

    2016-05-01

    Death is the most severe consequence of violence against women. The purpose of this study was to determine the frequency of violence-related deaths among women and the general characteristics of fatal violence cases against women in Istanbul, Turkey. A total of 20,486 forensic autopsies performed between 2006 and 2010, in Istanbul, were retrospectively analyzed. Of these, 537 violence-related deaths among women were included in the study. The victims were investigated in terms of sociodemographic characteristics, exposed type of violence, and autopsy findings. Out of all female deaths (n = 4165), 12.9% were due to violence against women, which comprised 2.6% of all autopsies (n = 20,456) performed during the study period in Istanbul. The median age of the victims was 43 years, and a significant proportion of victims (49.7%) were between the ages of 21 and 40 years. The deaths occurred most commonly in private residences (51.2%, n = 275), whereas the street was the crime scene for 14.5% (n = 78) of cases. Firearm injuries (50.1%, n = 269) were the most common cause of death, followed by stab wounds (28.3%, n = 152) and strangulation (8.4%, n = 45). Among the identified perpetrators, 52.3% were victims' spouses or boyfriends. The perpetrators were female in 4.4% (n = 16) of cases. Istanbul is the most important and cosmopolitan city of Turkey, representing the country's cultural characteristics. Therefore, the data obtained in this study may be strong indicators of violence against women in Turkey. PMID:27016881

  20. An Autopsy Study of Liver Injuries in a Tertiary Referral Centre of Eastern Nepal

    PubMed Central

    Subedi, Nuwadatta; Yadav, B.N.; Jha, Shivendra; Gurung, Sharmila; Pradhan, Amshu

    2013-01-01

    Background: Liver is the largest gland in the body and it frequently gets wounded. The objective of this study was to determine the patterns, types and severities of liver injuries which were caused by mechanical trauma and to study the organs associated with liver injuries. Material and Methods: This was a hospital based, cross sectional study which was conducted on the autopsies showing the evidence of liver injuries in the mortuary of a tertiary hospital in eastern Nepal. All consecutive autopsy cases which were handled within one year’s time (n=46) were included in our study. The cases were studied in detail for liver injuries, which included age, sex, severity, associated injuries, site of the injury, description of the injury, etc. Results: The mean age of the victims was 33.87 years and there was a male: female ratio of 3.6:1. The injuries had resulted from blunt trauma in 41 (89.1%) cases, the most common of which was road traffic accidents, constituting 37(80.4%) cases. Grade III injuries were seen in 14 (30.4%) cases. Laceration of the liver was the most frequent finding that was evident in 34 (73.9%) cases. Right lobe of the liver was injured in 30 (74%) cases. The sole presence of liver injuries among abdomino-pelvic organs was seen in 14 (30.4%) cases. In 40 (87%) cases, liver injuries were associated with other regional injuries. Conclusion: Laceration is the most common liver injury among autopsy cases. Right lobe is mostly affected and grade III injuries are the most common ones. Liver injuries are frequently associated with other abdomino-pelvic organs and multiple regional injuries. PMID:24086875

  1. An Autopsy Case of Fulminant Amebic Colitis in a Patient with a History of Rheumatoid Arthritis

    PubMed Central

    Kawabe, Naoko; Nagasawa, Miho; Nakanishi, Masako

    2016-01-01

    Generally, amebic colitis is localized around the mucosal membrane and often accompanied by diarrhea and abdominal pain. We describe a patient with a history of rheumatoid arthritis who had received prolonged steroid therapy. The patient complained of breathing difficulties because of rheumatoid lung disease. Although the patient was given antibacterial agent, the symptoms did not improve until death. We did an autopsy and found that he had fulminant amebic colitis, although the patient was not previously examined. Histochemical analysis revealed severe inflammation and full-thickness necrosis of the colon by ameba, suggesting the involvement of ameba in the progression of the overall condition. PMID:27382497

  2. Organochlorine residues and autopsy data from bald eagles 1966-68

    USGS Publications Warehouse

    Mulhern, B.M.; Reichel, W.L.; Locke, L.N.; Lamont, T.G.; Belisle, A.A.; Cromartie, E.; Bagley, G.E.; Prouty, R.M.

    1970-01-01

    Sixty-nine bald eagles found moribund or dead in 25 States during 1966-68 were analyzed for pesticide residues. Residues of polychlorinated biphenyls and DDE were detected in all samples of eagle carcasses; residues of dieldrin were detected in 68 and residues of DDD in 64; DDT, heptachlor epoxide, and DCBP were detected less frequently. Eight specimens had levels of dieldrin in the brain within the lethal range, and another probably died of DDT poisoning. Autopsy revealed that illegal shooting was the most frequent cause of mortality of these eagles; electrocution, impact injuries, probable lead poisoning, and infectious avian diseases were other causes of mortality.

  3. Comparison of organochlorine residues in human adipose tissue autopsy samples from two Ontario municipalities

    SciTech Connect

    Williams, D.T.; LeBel, G.L.; Junkins, E.

    1984-01-01

    Human adipose tissue samples obtained during autopsies in a Canadian Great Lakes community, Kingston, Ontario, and a second community, Ottawa, Ontario, were analyzed for organochlorine pesticides, polychlorobiphenyls, chlorobenzenes, and chlorophenols. Significantly different levels of Dichlorodiphenyl-dichlorethane, mirex, hexachlorobenzene, and 2,3,4,6-tetrachlorophenol were found in Kingston adipose tissues compared to Ottawa tissues. Residue levels of oxychlordane, mirex, and polychlorinated biphenyls were significantly different in Kingston males versus Kingston females. The means and ranges of residue levels were contrasted with those reported in previous Canadian surveys.

  4. Residues of organochlorine pesticides and polychlorinated biphenyls and autopsy data for bald eagles, 1973-74

    USGS Publications Warehouse

    Prouty, R.M.; Reichel, W.L.; Locke, L.N.; Belisle, A.A.; Cromartie, E.; Kaiser, T.E.; Lamont, T.G.; Mulhern, B.M.; Swineford, D.M.

    1977-01-01

    Thirty-nine bald eagles found sick or dead in 13 States during 1969 and 1970 were analyzed for pesticide residues. Residues of DDE, dieldrin, polychlorinated biphenyls (PCB's), and mercury were detected in all bald eagle carcasses; DDD residues were detected in 38; DDT, heptachlor epoxide, and dichlorobenzophenone (DCBP) were detected less frequently. Six eagles contained possible lethal levels of dieldrin in the brain, and one contained a lethal concentration of DDE (385 ppm) in the brain together with 235 ppm of PCB's. Autopsy revealed that 18 bald eagles were illegally shot; other causes of death were impact injuries, electrocution, emaciation, and infectious diseases.

  5. Residues of organochlorine pesticides and polychlorinated biphenyls and autopsy data for bald eagles, 1971-72

    USGS Publications Warehouse

    Cromartie, E.; Reichel, W.L.; Locke, L.N.; Belisle, A.A.; Kaiser, T.E.; Lamont, T.G.; Mulhern, B.M.; Prouty, R.M.; Swineford, D.M.

    1975-01-01

    Thirty-seven bald eagles found sick or dead in 18 States during 1971-72 were analyzed for organochlorine pesticides and polychlorinated biphenyls (PCB's). DDE and PCB's were detected in all bald eagle carcasses; 30 carcasses contained DDD and 28 contained dieldrin. Four eagles contained possibly lethal levels of dieldrin and nine eagles had been poisoned by thallium. Autopsies revealed that illegal shooting was the most common cause of mortality. Since 1964 when data were first collected, 8 of the 17 eagles obtained from Maryland, Virginia, South Carolina, and Florida possibly died from dieldrin poisoning; all four specimens from Maryland and Virginia were from the Chesapeake Bay Tidewater area.

  6. Acute respiratory distress syndrome due to systemic lupus erythematosus with hemophagocytic syndrome: an autopsy report.

    PubMed

    Kaneko, Kazuma; Matsuda, Masayuki; Sekijima, Yoshiki; Hosoda, Waki; Gono, Takahisa; Hoshi, Kenichi; Shimojo, Hisashi; Ikeda, Shu-ichi

    2005-04-01

    This report concerns a patient with systemic lupus erythematosus (SLE) who died of acute respiratory distress syndrome (ARDS) 1 day after the onset of pulmonary symptoms. Autopsy demonstrated severe hemophagocytosis in the bone marrow and histopathology indicating a marked increase in vascular permeability in both lungs and kidneys. In this patient, active SLE and associated hemophagocytic syndrome may have induced an increase in the production of inflammatory cytokines, which immediately induced ARDS. Since fatal ARDS can occur as a life-threatening complication of SLE, careful observation is necessary, particularly when there are clinical findings suggestive of associated hemophagocytic syndrome. PMID:15338452

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

    PubMed Central

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

    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. 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. PMID:23539438

  8. Brain Autopsy

    MedlinePlus

    ... be sufficient to reach a definitive diagnosis. The Importance of Planning Ahead AFTD Board member Colleen Quinn ... of your loved one all of the relevant professionals can be in direct contact with each other ...

  9. Diagnosis of causes of childhood deaths in developing countries by verbal autopsy: suggested criteria. The SEARCH Team.

    PubMed Central

    Bang, A. T.; Bang, R. A.

    1992-01-01

    In the absence of medical certification of deaths in developing countries, lay reporting and verbal autopsy have emerged as useful alternative methods for collecting data on causes of death. Of these, verbal autopsy offers advantages and is widely used in field studies and child survival programmes. However, because uniform and valid criteria for the diagnosis of common causes of death are lacking, comparison of the results of different studies becomes meaningless. This article proposes such a set of criteria for the cause of death among neonates and for those aged 1-59 months. The criteria are based on the findings of earlier validation studies, a Delphi survey and the experience gained from performing 1000 verbal autopsies in Gadchiroli, India. The emergence of such standardized criteria of causes of death should be of immense value for health planning, monitoring and evaluation purposes and for interregional comparisons. PMID:1394784

  10. Consistency versus Completeness in Medical Decision Making: Exemplar of 155 Patients Autopsied after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Moore, G. William; Hutchins, Grover M.

    1982-01-01

    Diagnoses made at autopsy are usually yes-no (binary) decisions inferred from clinicopathologic data. A major conceptual problem in determining cause of death is that variables used in classifying some patients may be missing in other patients. A model with too few logical implications will be mathematically incomplete for small data sets; but a model too many implications may be inconsistent with large data sets. We examined the 155 patients autopsied after coronary artery bypass surgery from The Johns Hopkins Hospital autopsy database of 43200 cases. Diagnoses entered on a word processor and transmitted to a minicomputer were solved by the Quine-McCluskey algorithm. Our analysis disclosed that 41% of patients suffered a fatal complication of cardiac surgery; 43% had established surgical complications or unrelated causes of death; and in 17% of cases the cause of death was unexplained. Computerized symbolic logic analysis of medical information is useful in testing the completeness of a proposed set of causes of death.

  11. A forensic autopsy case of death from laryngeal stenosis due to a late complication of radiotherapy.

    PubMed

    Suzuki, Hideto; Tanifuji, Takanobu; Hasegawa, Iwao; Fukunaga, Tatsushige

    2016-05-01

    Irradiation is one of the standard modalities of treatment for neck cancer; however, it occasionally causes severe late complications. Here, we report an autopsy case of a death from laryngeal stenosis due to a late complication of radiotherapy. A man in his 70s who underwent radiotherapy for laryngeal cancer 6months before death was found dead in his home. Complete regression of the cancer was obtained after treatment, and signs suggestive of cancer recurrence were not evident before his death. Postmortem computed tomography showed severe narrowing of the upper airway due to glottic tissue swelling. The autopsy revealed an edematous epiglottis and supraglottic-glottic tissue with an ulcerative lesion, which severely narrowed the upper airway. Histopathological findings showed edema, hyalinization, and a proliferation of granulation tissue at the affected site. Neither a gross recurrence of cancer or finding suggestive of infection was observed in the specimen. This case is instructive to forensic pathologists regarding noting a radiotherapy complication as one of the possible causes of sudden death when the decedent previously underwent radiotherapy for neck cancer, and stresses the importance of detailed history taking and careful examination of the neck organs. PMID:27161915

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

    PubMed

    Minayo, Maria Cecília de Souza; Cavalcante, Fátima Gonçalves; Mangas, Raimunda Matilde do Nascimento; Souza, Juliana Rangel Alves de

    2012-10-01

    This study analyses psychological autopsies and contextualizes problems and issues that led to elderly people taking their own lives in the city of Rio de Janeiro between 2004 and 2007. The study began with an analysis of 26 expert findings of elderly men and women who committed suicide in the central, northern and southern areas of Rio de Janeiro. The sample was contacted by letter and telephone and after that, by a one-on-one conversation. Eight psychological autopsies were conducted, in which identification data and family genograms were collected followed by an interview to profile the life style and the reasons for the self-inflicted violence. The interviewees were family members, friends and acquaintances of the victims. The suicides are associated with depression, serious physical and mental illness, as well as socio-cultural factors related to professional and socio-economic decline. The suicides occurred with and without family support, with and without medical care. The cumulative fragility of personal and social resources within the life cycle reveals that the risk of suicide among the elderly demands permanent care from the public health authorities. PMID:23099763

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

    PubMed

    Kawamoto, Osamu; Ishikawa, Takaki; Oritani, Shigeki; Kuramoto, Yuko; Michiue, Tomomi; Maeda, Hitoshi

    2013-06-01

    We report an autopsy case of death due to accidental ingestion of a liquid laundry detergent with special regard to the histochemical findings. A female inpatient suffering from schizophrenia in a psychiatric institution, was found unconscious lying on the floor of her room, with a container of detergent nearby, and died despite intensive life-support measures. At autopsy, the stomach and duodenum contained whitish translucent foamy viscous fluid, and the mucous membranes, from the esophagus to the duodenum, had diffuse erosions with congestion and edema. There was otherwise no significant pathology other than signs of acute death and hemolysis. Toxicological investigations detected 1-methyl-4-prop-1-en-2-ylcyclohexene (detergent additive) in the gastric contents using headspace-gas chromatography/mass spectrometry, and a nonionic surfactant by a color identification test. Although these substances could not be detected in the blood, body fluid or viscera, histochemical examination using Oil red O demonstrated droplet-like staining in the pulmonary alveoli, suggesting aspiration of detergent, and similar staining in the vasculature of the lung, Kupffer cells of the liver, Bowman capsules of the kidney, and capillaries of the brain, suggesting the systemic effect of ingested/aspirated detergent. These findings were in keeping with death from ingestion of detergent and demonstrated the importance of preventing accidents such as this in healthcare facilities for elderly people. PMID:23212210

  14. Autopsy findings for a case of acute gastric volvulus in a child.

    PubMed

    Kozawa, Shuji; Murakami, Tomonori; Kakizaki, Eiji; Ikemura, Mayumi; Nakagawa, Yasuhisa; Kiyofuji, Yuma; Ikematsu, Kazuya; Nata, Masayuki

    2015-09-01

    Acute gastric volvulus resulting in abdominal compartment syndrome was determined to be the cause of death in a 4-year-old girl who presented with abdominal distension. At about 1AM on the day of her death, she was brought to our emergency medical center. Physical examination and plain abdominal X-ray revealed pronounced gastric dilatation. A decompression procedure was performed, followed by observation. She went into cardiopulmonary arrest around 1PM on the same day and died. Postmortem investigation, including an autopsy and computed tomography (CT), was performed to determine the cause of death. The findings included that the stomach was severely distended. Evidence was seen of mucosal hemorrhage in the gastric mucosa on the greater curvature side, which was thinned in places but without perforation. No necrosis of the gastric mucosa was observed; reversible changes were evident on histopathological examination. The postmortem CT images suggested that the pyloric region was positioned cranioventrally to the cardiac region. None of the findings indicated sudden blockage, and the cause of death was determined to be acute gastric volvulus resulting in abdominal compartment syndrome. The abnormal placement of the organs was difficult to determine based on physical examination alone; postmortem CT and careful examination were helpful in conducting the autopsy in this case. PMID:25957510

  15. Causes of death in renal transplant recipients: a study of 102 autopsies from 1968 to 1991.

    PubMed Central

    Reis, M A; Costa, R S; Ferraz, A S

    1995-01-01

    A study was conducted on 102 patients submitted to renal transplant who died and were autopsied at the University Hospital, Faculty of Medicine of Ribeirão Preto, Brazil, from 1968 to 1991. The cause of death, based on a review of medical records and autopsy reports, was assigned to one of the following categories: infectious (69.6%); cardiovascular (12.7%); gastrointestinal (7.8%); graft rejection (6.9%); tumoral (2.0%); and undetermined (1.0%). Among the 71 cases of death caused by infection, 28 (39.4%) showed disseminated agents involving two or more organs. Isolated pneumonia involved 17 patients (23.9%), followed by acute pyelonephritis in the transplanted kidney in 10 patients (14.1%). The most frequent agents were: bacteria (58.0%), divided into 'non-classified' (83.0%), Nocardia (10.6%) and Mycobacterium (6.4%); fungi (27.5%) represented by Cryptococcus (22.7%), Aspergillus, Candida and Pneumocystis carinii (18.1% each), Histoplasma (13.6%), Mucor and Paracoccidioides brasiliensis (4.5% each); viruses (6.2%) represented by Herpes simplex (60.0%); metazoa (5.0%, S. stercoralis), and protozoa (2.5%, T. cruzi). Cytomegalovirus (CMV) was identified in the lungs of 12 patients and was not directly correlated with death but was associated with other agents. In conclusion, immunodepressed patients such as renal transplant recipients should be carefully monitored for infection due to the high mortality rate. PMID:7884765

  16. [Smoldering adult T-cell leukemia complicating severe respiratory failure--an autopsy case report].

    PubMed

    Maekawa, I; Yosida, K; Hirasawa, K; Mayumi, T; Kanda, M

    1987-03-01

    An autopsy case of smoldering adult T-cell leukemia (ATL) is presented. 67 year-old woman was admitted to our hospital with complaints of fever, cough and increasing dyspnea on October 2, 1985. Laboratory findings revealed high LDH, azothermia and slightly leukocytosis with low percentage of flower cells. CRP was strongly positive. Gas disturbance was markedly. Anti-ATLA antibody using indirect immunofluorescence method was X40 positive. Subsets of peripheral lymphocytes showed OKT 4 dominant. (OKT 3; 67.5%, OKT4; 60.6%, OKT8; 8.8%). A chest X-ray film revealed cardiomegaly and fine granular shadows in bilateral lower pulmonary fields. Diagnosis of interstitial pneumonitis was defined in transbronchial lung biopsy (TBLB) specimen. O2 therapy, steroid therapy added antibiotics were ineffective, respiratory failure and renal failure were progressive, she died by septic shock in 39th hospital days. In autopsy, no characteristic histological changes of ATL were found in lymph node, bone marrow, spleen, liver, kidney and lung. Sepsis was the cause was of death. Finally this case diagnosed smoldering ATL and pulmonary fibrosis due to bronchial ectasia with repeated pulmonary bacterial infections. The pulmonary complications of patients with ATL were discussed. PMID:2886412

  17. [An Autopsy Case of Globular Glial Tauopathy Presenting with Amyotrophic Lateral Sclerosis with Dementia].

    PubMed

    Sasaki, Ryogen; Mimuro, Maya; Kokubo, Yasumasa; Imai, Hiroshi; Yoshida, Mari; Tomimoto, Hidekazu

    2016-08-01

    We report an autopsy case of globular glial tauopathy (GGT) presenting clinically with amyotrophic lateral sclerosis (ALS) with dementia. A 79-year-old female developed weakness in the right upper limb, which progressed gradually. She developed apathy and speech disorder at 80 years of age. On neurological examination, she showed signs of upper and lower motor neuron disorder and dementia, but no extrapyramidal signs. The clinical diagnosis was ALS with dementia. The autopsy revealed left predominant marked atrophy of the frontal lobe due to severe neuronal loss and Gliosis. Immunohistochemistry using anti-4-repeat tau antibody revealed numerous globular glial inclusions. Severe neurodegeneration in the primary motor cortex and corticospinal tract was observed. There were distinctive tau-positive inclusions in both Betz and anterior horn cells. TDP-43-positive inclusions in motor neurons were not detected. Sequence analysis of the tau gene revealed no mutations in exons 1-5, 7, 9-13, or the adjacent intronic sequences. GGT can cause a clinical phenotype of ALS with dementia. (Received December 28, 2015; Accepted February 23, 2016; Published August 1, 2016). PMID:27503823

  18. Incidentally Detected Lithopedion in an 87-Year-Old Lady: An Autopsy Case Report.

    PubMed

    Gürler, Ahmet Selçuk; Daş, Taner; Gitmiş, Gökhan; Apaydin, Nedim; Kara, Erdoğan; Özdemirel, Rifat Özgür; Çelik, Safa; Özdeş, Emel; Sezer, Yiğit

    2016-09-01

    A lithopedion is a rare complication of pregnancy that occurs when a fetus in an intraabdominal location dies, and it is too large to be reabsorbed by the body. The case was an 87-year-old woman, and she was transferred to the morgue department in April 2014 to determine the cause of death. During autopsy, an intraabdominally located calcified dead fetus and a 12-cm diameter calcified cyst in the right ovary were incidentally detected. It was aged 25 to 29 weeks (according to femur and humerus measurements) with a size of 12.5 × 8 × 5 cm and a weight of 227 g. According to investigation reports, her husband died in 1990, and she had 3 deliveries, the most recent of which was in 1946. Because the menopause age of the case was not exactly known, the retention time of the lithopedion was supposed to be 24 to 68 years according to the date of the most recent pregnancy and the date of her spouse's death. It is the first case that has been incidentally detected and identified during an autopsy in Turkey and also one of the oldest cases in the literature. PMID:27389692

  19. Evaluation of Ultrasonic Fiber Structure Extraction Technique Using Autopsy Specimens of Liver

    NASA Astrophysics Data System (ADS)

    Yamaguchi, Tadashi; Hirai, Kazuki; Yamada, Hiroyuki; Ebara, Masaaki; Hachiya, Hiroyuki

    2005-06-01

    It is very important to diagnose liver cirrhosis noninvasively and correctly. In our previous studies, we proposed a processing technique to detect changes in liver tissue in vivo. In this paper, we propose the evaluation of the relationship between liver disease and echo information using autopsy specimens of a human liver in vitro. It is possible to verify the function of a processing parameter clearly and to compare the processing result and the actual human liver tissue structure by in vitro experiment. In the results of our processing technique, information that did not obey a Rayleigh distribution from the echo signal of the autopsy liver specimens was extracted depending on changes in a particular processing parameter. The fiber tissue structure of the same specimen was extracted from a number of histological images of stained tissue. We constructed 3D structures using the information extracted from the echo signal and the fiber structure of the stained tissue and compared the two. By comparing the 3D structures, it is possible to evaluate the relationship between the information that does not obey a Rayleigh distribution of the echo signal and the fibrosis structure.

  20. An autopsy case of preclinical multiple system atrophy (MSA-C).

    PubMed

    Kon, Tomoya; Mori, Fumiaki; Tanji, Kunikazu; Miki, Yasuo; Wakabayashi, Koichi

    2013-12-01

    Multiple system atrophy (MSA) is divided into two clinical subtypes: MSA with predominant parkinsonian features (MSA-P) and MSA with predominant cerebellar dysfunction (MSA-C). We report a 71-year-old Japanese man without clinical signs of MSA, in whom post mortem examination revealed only slight gliosis in the pontine base and widespread occurrence of glial cytoplasmic inclusions in the central nervous system, with the greatest abundance in the pontine base and cerebellar white matter. Neuronal cytoplasmic inclusions (NCIs) and neuronal nuclear inclusions (NNIs) were almost restricted to the pontine and inferior olivary nuclei. It was noteworthy that most NCIs were located in the perinuclear area, and the majority of NNIs were observed adjacent to the inner surface of the nuclear membrane. To our knowledge, only four autopsy cases of preclinical MSA have been reported previously, in which neuronal loss was almost entirely restricted to the substantia nigra and/or putamen. Therefore, the present autopsy case of preclinical MSA-C is considered to be the first of its kind to have been reported. The histopathological features observed in preclinical MSA may represent the early pattern of MSA pathology. PMID:23581648

  1. An unusual autopsy case of lethal hypothermia exacerbated by body lice-induced severe anemia.

    PubMed

    Nara, Akina; Nagai, Hisashi; Yamaguchi, Rutsuko; Makino, Yohsuke; Chiba, Fumiko; Yoshida, Ken-ichi; Yajima, Daisuke; Iwase, Hirotaro

    2016-05-01

    Pediculus humanus humanus (known as body lice) are commonly found in the folds of clothes, and can cause skin disorders when they feed on human blood, resulting in an itching sensation. Body lice are known as vectors of infectious diseases, including typhus, recurrent fever, and trench fever. An infestation with blood-sucking body lice induces severe cutaneous pruritus, and this skin disorder is known as "vagabond's disease." A body lice infestation is sometimes complicated with iron deficiency anemia. In the present case, a man in his late 70s died of lethal hypothermia in the outdoors during the winter season. The case history and autopsy findings revealed that the cause of the lethal hypothermia was iron deficiency anemia, which was associated with a prolonged infestation of blood-sucking body lice. Also, he had vagabond's disease because the skin on his body was abnormal and highly pigmented. This is an unusual autopsy case since the body lice contributed to the cause of the death. PMID:26384507

  2. An autopsy case of cardiac tamponade caused by a ruptured ventricular aneurysm associated with acute myocarditis.

    PubMed

    Kondo, Takeshi; Nagasaki, Yasushi; Takahashi, Motonori; Nakagawa, Kanako; Kuse, Azumi; Morichika, Mai; Sakurada, Makoto; Asano, Migiwa; Ueno, Yasuhiro

    2016-01-01

    We report an autopsy case of hemopericardium caused by rupture of a ventricular aneurysm associated with acute myocarditis in an infant boy aged 2 years and 10 months. Three days before his death, the patient developed fever. On the day of death, he described an urge to defecate and attempted to do so in an upright position. While straining to defecate without success for a prolonged period, he stopped breathing and collapsed. On autopsy, his heart weighed 91.7 g and cardiac tamponade was evident, the pericardial cavity being filled with 140 mL of blood that had come from a 1.5-cm-long rupture in a 2.7×1.5 cm ventricular aneurysm in the posterior left ventricular wall. Patchy grayish-white discoloration was noted in the myocardium. Histologically, CD3-positive T lymphocytic infiltration accompanied by pronounced macrophage infiltration was observed in the myocardium. Hemorrhagic necrosis was detected in the area of the ventricular aneurysm. Staining for matrix metalloproteinase (MMP) expression revealed abundant MMP-2, MMP-7, and MMP-9. Polymerase chain reaction to detect viruses failed to identify any specific causative viruses in the myocardium. In this case of lymphocytic (viral) and histiocytic myocarditis with pronounced macrophage infiltration and upregulation of MMP expression, myocardial remodeling and associated wall weakening had resulted in formation and rupture of an aneurysm. PMID:26832375

  3. Evaluation of Postmortem Drug Concentrations in Bile Compared with Blood and Urine in Forensic Autopsy Cases.

    PubMed

    Tominaga, Mariko; Michiue, Tomomi; Oritani, Shigeki; Ishikawa, Takaki; Maeda, Hitoshi

    2016-06-01

    For drug screening and pharmaco-/toxicokinetic analysis, bile as a major drug excretion route in addition to urine may be used in forensic autopsy cases; however, there are limited published data on correlations between bile and blood or urine drug concentrations. The present study retrospectively investigated drug concentrations in bile, compared with blood and urine concentrations, reviewing forensic autopsy cases during 6 years (January 2009-December 2014). Drugs were analyzed using automated gas chromatography-mass spectrometry following solid-liquid phase extraction. Compared with peripheral blood concentrations, bile concentrations were higher for most drugs; however, caffeine concentrations were similar. Bile concentrations were mostly lower than urine concentrations for amphetamines, caffeine and methylephedrine, but were usually similar to or higher for other drugs. Significant correlations were detected between bile and peripheral blood concentrations for amphetamines, several cold remedies, phenobarbital, phenothiazine derivatives and diazepam, as well as between bile and urine concentrations for amphetamines, caffeine, diphenhydramine, phenobarbital and promethazine derivatives. These findings suggest that bile can provide supplemental data useful in routine forensic toxicology, for the spectrum of drugs mentioned above, as well as for investigating pharmaco-/toxicokinetics and postmortem redistribution when analyzed in combination with drug concentrations at other sites. PMID:27185819

  4. Sudden cardiac death in the young: the molecular autopsy and a practical approach to surviving relatives.

    PubMed

    Semsarian, Christopher; Ingles, Jodie; Wilde, Arthur A M

    2015-06-01

    The sudden death of a young, apparently fit and healthy person is amongst the most challenging scenarios in clinical medicine. Sudden cardiac death (SCD) is a devastating and tragic outcome of a number of underlying cardiovascular diseases. While coronary artery disease and acute myocardial infarction are the most common causes of SCD in older populations, genetic (inherited) cardiac disorders comprise a substantial proportion of SCD cases aged 40 years and less. This includes the primary arrhythmogenic disorders such as long QT syndromes and inherited cardiomyopathies, namely hypertrophic cardiomyopathy. In up to 30% of young SCD, no cause of death is identified at postmortem, so-called autopsy-negative or sudden arrhythmic death syndrome (SADS). Management of families following SCD begins with a concerted effort to identify the cause of death in the decedent, based on either premorbid clinical details or the pathological findings at postmortem. Where no cause of death is identified, genetic testing of deoxyribonucleic acid extracted from postmortem blood (the molecular autopsy) may identify a cause of death in up to 30% of SADS cases. Irrespective of the genetic testing considerations, all families in which a sudden unexplained death has occurred require targeted and standardized clinical testing in an attempt to identify relatives who may be at-risk of having the same inherited heart disease and therefore also predisposed to an increased risk of SCD. Optimal care of SCD families therefore requires dedicated and appropriately trained staff in the setting of a specialized multidisciplinary cardiac genetic clinic. PMID:25765769

  5. A Histomorphological Pattern Analysis of Pulmonary Tuberculosis in Lung Autopsy and Surgically Resected Specimens

    PubMed Central

    Lobo, Flora D.; Adiga, Deepa Sowkur Anandarama

    2016-01-01

    Background. Tuberculosis (TB) is a major cause of morbidity and mortality globally. Many cases are diagnosed on autopsy and a subset of patients may require surgical intervention either due to the complication or sequelae of TB. Materials and Methods. 40 cases of resected lung specimens following surgery or autopsy in which a diagnosis of pulmonary tuberculosis was made were included. Histopathological pattern analysis of pulmonary tuberculosis along with associated nonneoplastic changes and identification of Mycobacterium tuberculosis bacilli was done. Results. The mean age of diagnosis was 41 years with male predominance (92.5%). Tuberculosis was suspected in only 12.1% of cases before death. Seven cases were operated upon due to associated complications or suspicion of malignancy. Tubercular consolidation was the most frequent pattern followed by miliary tuberculosis. The presence of necrotizing granulomas was seen in 33 cases (82.5%). Acid fast bacilli were seen in 57.5% cases on Ziehl-Neelsen stain. Conclusion. Histopathology remains one of the most important methods for diagnosing tuberculosis, especially in TB prevalent areas. It should be considered in the differential diagnosis of all respiratory diseases because of its varied clinical presentations and manifestations. PMID:27088035

  6. Neoplastic lesions in CADASIL syndrome: report of an autopsied Japanese case

    PubMed Central

    Hassan, Wael Abdo; Udaka, Naoka; Ueda, Akihiko; Ando, Yukio; Ito, Takaaki

    2015-01-01

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is one of the most common heritable causes of stroke and dementia in adults. The gene involved in the pathogenesis of CADASIL is Notch3; in which mutations affect the number of cysteine residues in its extracellular domain, causing its accumulation in small arteries and arterioles of the affected individuals. Besides the usual neurological and vascular findings that have been well-documented in CADASIL patients, this paper additionally reports multiple neoplastic lesions that were observed in an autopsy case of CADASIL patient; that could be related to Notch3 mutation. The patient was a 62 years old male, presented with a past history of neurological manifestations, including gait disturbance and frequent convulsive attacks. He was diagnosed as CADASIL syndrome with Notch3 Arg133Cys mutation. He eventually developed hemiplegia and died of systemic convulsions. Autopsy examination revealed-besides the vascular and neurological lesions characteristic of CADASIL- multiple neoplastic lesions in the body; carcinoid tumorlet and diffuse idiopathic pulmonary neuro-endocrine cell hyperplasia (DIPNECH) in the lungs, renal cell carcinoma (RCC), prostatic adenocarcinoma (ADC) and adenomatoid tumor of the epididymis. This report describes a spectrum of neoplastic lesions that were found in a case of CADASIL patient that could be related to Notch3 gene mutations. PMID:26261665

  7. Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study.

    PubMed

    Mehta, Rupal I; Mehta, Rashi I; Choi, Julia M; Mukherjee, Arnob; Castellani, Rudy J

    2015-02-01

    Hydrophilic polymers are commonly applied as surface coatings on vascular devices and have been shown to dissociate during endovascular use, causing hydrophilic polymer embolism (HPE). Adverse effects related to this phenomenon have been recognized and reported. The prevalence of this complication is unknown. We conducted a retrospective study to determine the prevalence of HPE among hospital autopsies over a 29-month period. Postmortem tissue was histologically evaluated for the presence, location(s) and extent of HPE. HPE findings were correlated with documented clinical and laboratory data and patient outcome. Of 136 hospital autopsies examined, 18 (13%) showed evidence of HPE involving the lungs (n = 18), heart (n = 1) or central nervous system (n = 1). Localized pulmonary HPE was seen in 12 patients (9%). Multifocal pulmonary HPE was found in 6 patients (4%) and was associated with clinical vasculitis (33%; P < .0001), suspected pulmonary ischemia (50%; P = .008), coagulopathy (67%; P = .002), and constitutional disease (83%; P = .01). Within affected lung, associated histopathologic changes included occlusive intravascular or perivascular inflammation (89%), intravascular fibrous response (56%), microthrombus formation (44%), vasculitis (28%), and/or pulmonary microinfarction (28%). Statistically significant differences in hospital days (P = .008) and number of vascular interventions (P = .01) were noted between affected and unaffected patients. We conclude that HPE is an underdiagnosed phenomenon with primary involvement of the lungs, where secondary vascular changes are common. Additional studies may be needed to clarify risks and to identify preventative strategies for this iatrogenic complication of catheterizations and "minimally invasive" endovascular techniques. PMID:25543660

  8. A review of autopsy reports on chimpanzees in or from US laboratories.

    PubMed

    Capaldo, Theodora; Peppercorn, Marge

    2012-10-01

    Approximately 1000 chimpanzees are currently held in five federally owned, or supported, US laboratories. This study reviews 110 autopsy reports on chimpanzees who died from 2001-2011 in laboratories or in sanctuaries (but who were from laboratories), in order to glean information about their premorbid health and causes of death. The findings raise questions about the health status of the chimpanzees remaining in laboratories. Most of the chimpanzees currently held are not involved in active protocols. The Chimpanzee Health Improvement, Maintenance, and Protection (CHIMP) Act 2000 states that chimpanzees "not needed" for research "shall" be accepted into the federal sanctuary system, but criteria for when a chimpanzee is deemed "not needed" are not given. The assessment of "not needed" lies with the Secretary of Health and Human Services, who has left the decision to the discretion of the laboratories. This autopsy review revealed that the majority of the chimpanzees who died in laboratories had been suffering from significant chronic or incurable illnesses, and most often had multi-system diseases that should have made them ineligible for future research, on scientific, as well as ethical, grounds. The study's findings are significant in establishing the need for defined criteria for chimpanzee retirement to sanctuary. PMID:23215662

  9. The Lowest Prevalence of Cholelithiasis in the Americas - An Autopsy-based Study

    PubMed Central

    Asperti, André Marangoni; Reis, Paulo; Diniz, Marcio Augusto; Pinto, Mariana Dourado; da Silva, Edinésio Carlos; da Silva, Danilo Felipe Dias; D’Albuquerque, Luiz Augusto Carneiro; Andraus, Wellington

    2016-01-01

    OBJECTIVES: This study used autopsy to evaluate the prevalence of cholelithiasis and its associated risk factors in a population of healthy, young subjects who suffered a violent or natural death. METHODS: This study is a prospective evaluation of autopsies of 446 individuals from 2011 to 2013 in Brazil. Of that sample, 330 (74%) subjects died from violent deaths and 116 (26%) died naturally. The presence of biliary calculi, previous cholecystectomy, gender, age, ethnicity, body mass index (BMI) and alcohol use were evaluated. RESULTS: In the natural death group, 6.9% (95% CI 3.39 to 13.28) (3.08% of the male subjects and 11.76% of the female subjects) exhibited evidence of gallbladder disease. In the violent death group, only 2.12% (95% CI 0.96 to 4.43) (2.17% of the male subjects and 1.85% of the female subjects) of the subjects exhibited evidence of gallbladder disease. Age was correlated with the prevalence of gallbladder disease, but BMI was correlated with only gallbladder disease in the natural death group. CONCLUSIONS: This population has the lowest prevalence of cholelithiasis in the Americas. Dietary habits, physical activity, ethnicity, alcohol consumption and genetic factors may be responsible for this low prevalence. PMID:27464291

  10. A profile of abdominal and pelvic injuries in medico-legal autopsy.

    PubMed

    Subedi, Nuwadatta; Yadav, B N; Jha, Shivendra; Paudel, Ishwari Sharma; Regmi, Rajendra

    2013-08-01

    Abdomino-pelvic region is vulnerable to injury in various forms of trauma. This study was undertaken with objectives to study the pattern and type of external and internal abdominal and pelvic injuries and to identify the risk organs in abdomen and pelvis susceptible to trauma among the medico-legal autopsies at the mortuary of a referral centre in eastern Nepal during the period of one year (n = 80). Males constituted 80% of the cases and the mean age of the victims was 30.76 years. The cause of trauma was Road Traffic Accident in 82.5%. The manner of death was accidental in 87.5% and homicidal in 11.25% cases. Liver (57.5%) was the most common organ injured followed by spleen in 37.5% cases. Multiple organs injury was seen in 67.5% and absence of any external injuries was noted in 31.25% cases. Autopsy can play a role in establishing the missed injuries and be helpful to widen the knowledge of the medical faculty in early diagnosis and management of such injuries. PMID:23910883

  11. Trousseau's Syndrome Caused by Intrahepatic Cholangiocarcinoma: An Autopsy Case Report and Literature Review

    PubMed Central

    Yuri, Takashi; Kato, Kouta; Hirohara, y; Kinoshita, Yuichi; Emoto, Yuko; Yuki, Michiko; Yoshizawa, Katsuhiko; Tsubura, Airo

    2014-01-01

    An autopsy case report of Trousseau's syndrome caused by intrahepatic cholangiocarcinoma is presented, and seven previously reported cases are reviewed. A 73-year-old woman experiencing light-headedness and dementia of unknown cause for 6 months developed severe hypotonia. A hypointense lesion compatible with acute cerebral infarction was detected by magnetic resonance imaging. Abdominal computed tomography revealed an ill-defined large liver mass in the right lobe. The mass was not further investigated because of the patient's poor condition. She died of multiple organ failure, and an autopsy was conducted. Postmortem examination revealed intrahepatic cholangiocarcinoma, fibrous vegetations on the mitral valves and multiple thromboemboli in the cerebrum, spleen and rectum. Trousseau's syndrome is defined as an idiopathic thromboembolism in patients with undiagnosed or concomitantly diagnosed malignancy. This syndrome is encountered frequently in patients with mucin-producing carcinomas, while the incidence in patients with intrahepatic cholangiocarcinoma is uncommon. We found that tissue factor and mucin tumor marker (CA19-9, CA15-3 and CA-125) expression in cancer cells may be involved in the pathogenesis of thromboembolism. A patient with unexplained thromboembolism may have occult visceral malignancy; thus, mucin tumor markers may indicate the origin of a mucin-producing carcinoma, and postmortem examination may play an important role in revealing the hidden malignancy. PMID:24987359

  12. Terminal ballistics of the 7.62 mm NATO bullet. Autopsy findings.

    PubMed

    Knudsen, P J; Theilade, P

    1993-01-01

    The 7.62 mm x 51 military rifle bullet (7.62 mm NATO) as manufactured in Denmark, and in some other countries as well, has been claimed to fragment when fired at ranges encountered in forensic practice. All autopsied cases of death due to this bullet in Denmark since 1975 were investigated by studying autopsy reports and the bullets retrieved by the police. With one exception, all bullets that were found in, or known to have passed through the body, had fragmented. This behaviour is assumed to be due to a lack of strength in the jacket causing it to break at the cannelure when hitting the target at high velocity. The fragments will increase the already sizeable lesions and may leave the body through several separate exit wounds, presenting problems both for the surgeon treating survivors and for the forensic scientists when defining the direction of the shot. The legality of this and similar bullets in view of the Hague Declaration of 1899 may be questioned, and we feel that the bullet should be redesigned. A programme to this end has been initiated by the Danish state owned ammunition factory. PMID:8217867

  13. GLUT3 protein and mRNA in autopsy muscle specimens

    NASA Technical Reports Server (NTRS)

    Stuart, C. A.; Wen, G.; Jiang, J.

    1999-01-01

    GLUT3 is expressed in rat muscle, but this glucose transporter protein has not been identified previously in adult human skeletal muscle. We quantified the rapidity of disappearance of mRNA and protein from human skeletal muscle at room temperature and at 4 degrees C. Fifty percent of the immunologically detectable GLUT3 protein disappeared by 1 hour at 20 degrees C and by 2 hours at 4 degrees C. mRNA for GLUT3 was decreased 50% by 2.2 hours at 20 degrees C and by 24 hours at 4 degrees C. Half of the measurable mRNAs for GLUT4, glyceraldehyde 3-phosphate dehydrogenase (GAPDH), alpha-actin, and beta-myosin disappeared by 0.8 to 2.1 hours at 20 degrees C and by 5.0 to 16.6 hours at 4 degrees C. Previous conclusions that GLUT3 is not expressed in human muscle were likely drawn because of artifacts related to degradation of GLUT3 protein in the specimens prior to study. Because of the rapid degradation of protein and mRNA, autopsy specimens of muscle must be obtained within 6 hours of death, and even then, protein and mRNA data will likely dramatically underestimate their expression in fresh muscle. Some previously published conclusions and recommendations regarding autopsy specimens are not stringent enough to consistently yield useful protein and mRNA.

  14. A standardized autopsy procurement allows for the comprehensive study of DIPG biology

    PubMed Central

    Kambhampati, Madhuri; Perez, Jennifer P.; Yadavilli, Sridevi; Saratsis, Amanda M.; Hill, Ashley D.; Ho, Cheng-Ying; Panditharatna, Eshini; Markel, Melissa; Packer, Roger J.; Nazarian, Javad

    2015-01-01

    Diffuse intrinsic pontine glioma (DIPG) is one of the least understood and most deadly childhood cancers. Historically, there has been a paucity of DIPG specimens for molecular analysis. However, due to the generous participation of DIPG families in programs for postmortem specimen donation, there has been a recent surge in molecular analysis of newly available tumor specimens. Collaborative efforts to share data and tumor specimens have resulted in rapid discoveries in other pediatric brain tumors, such as medulloblastoma, and therefore have the potential to shed light on the biology of DIPG. Given the generous gift of postmortem tissue donation from DIPG patients, there is a need for standardized postmortem specimen accrual to facilitate rapid and effective multi-institutional molecular studies. We developed and implemented an autopsy protocol for rapid procurement, documenting and storing these specimens. Sixteen autopsies were performed throughout the United States and Canada and processed using a standard protocol and inventory method, including specimen imaging, fixation, snap freezing, orthotopic injection, or preservation. This allowed for comparative clinical and biological studies of rare postmortem DIPG tissue specimens, generation of in vivo and in vitro models of DIPG, and detailed records to facilitate collaborative analysis. PMID:25749048

  15. Validity of proxy data obtained by different psychological autopsy information reconstruction techniques.

    PubMed

    Fang, L; Zhang, J

    2010-01-01

    Two informants were interviewed for each of 416 living controls (individuals sampled from the normal population) interviewed in a Chinese case-control psychological autopsy study. The validity of proxy data, obtained using seven psychological autopsy information reconstruction techniques (types 1, 2 and A - E), was evaluated, with living controls' self reports used as the gold-standard. Proxy data for reconstruction technique types 1, 2 and D on the Impulsivity Inventory Scale (total impulsivity score) were no different from the living controls' self report gold standard, whereas data for types A and E were smaller than data from living controls. On the 'acceptance or resignation' sub-scale of the avoidance coping dimension of the Moos Coping Response Inventory, information obtained by reconstruction technique types 1 and D was not significantly different from the living controls' self reports, whereas proxy data from types 2, A and E were smaller than those from the living controls. No statistically significant differences were identified for other proxy data obtained by reconstruction technique types 1, 2, A, D and E. These results indicate that using a second informant does not significantly enhance information reconstruction for the target. PMID:20819420

  16. Validation study of a verbal autopsy method for causes of childhood mortality in Namibia.

    PubMed

    Mobley, C C; Boerma, J T; Titus, S; Lohrke, B; Shangula, K; Black, R E

    1996-12-01

    Verbal autopsy uses a caretaker interview to determine the cause of death. We conducted a study of the major causes of child death in Namibia to determine the validity of this method. A questionnaire, including signs and symptoms of the diagnoses of interest was administered to the caretaker in 135 deaths of children < 5 years old who were identified from hospital records. The 243 diagnoses included malnutrition (77), diarrhoea (73), pneumonia (36), malaria (33), and measles (24). Sensitivity and specificity of various algorithms of reported signs and symptoms were compared to the medical diagnoses. An algorithm for malnutrition (very thin or swelling) had 73 per cent sensitivity and 76 per cent specificity. An algorithm for cerebral malaria (fever, loss of consciousness or convulsion) had 72 per cent sensitivity and 85 per cent specificity, while for all malaria deaths the same algorithm had low sensitivity (45 per cent) and high specificity (87 per cent). For diarrhoea, loose or liquid stools had high sensitivity (89 per cent), but low specificity (61 per cent). Cough with dyspnoea or tachypnoea had 72 per cent sensitivity and 64 per cent specificity. An algorithm for measles (age > or = 120 days, rash) had 71 per cent sensitivity and 85 per cent specificity. The study results suggest verbal autopsy data can be useful to ascertain the leading causes of death in childhood, but may have limitations for health impact evaluation. PMID:9009566

  17. Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients.

    PubMed

    Roberts, C S; Roberts, W C

    1990-11-01

    Clinical and autopsy findings are described in 12 patients who had fatal aortic dissection with the entrance tear in the transverse aorta. The 12 patients represent 7% of 182 autopsies of spontaneous aortic dissection studied by us. The ages of the 12 patients at death ranged from 37 to 87 years (mean, 67 years). Eight were men; 8 had a history of systemic hypertension, and 10 had hearts of increased weight. Diagnosis of aortic dissection was made during life in only 4 of the 12 patients. All 12 patients died of rupture of the false channel within 2 weeks of onset of signs or symptoms compatible with dissection. The direction of aortic dissection from the entrance tear was entirely retrograde in 4 patients, entirely anterograde in 4 patients, and in both directions in 4 patients. Hemopericardium occurred in the first group, left hemothorax in the second group, and either in the last group. Of the 8 patients in whom the ascending aorta was involved, the retrograde dissection in each extended to the aortic root, 6 had pulmonary adventitial hemorrhage, and 4 had involvement of the arch arteries by dissection. In the 4 patients with strictly anterograde dissection, none had dissection in the arch arteries. Thus, tear in the transverse aorta causes a dissection that is usually fata, that often dissects retrogradely, and that may mimic dissection from a tear in ascending aorta. Aortic dissection from a tear in transverse aorta requires early operative intervention. PMID:2241339

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

    PubMed Central

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

    2001-01-01

    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. PMID:11436477

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

    PubMed Central

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

    2013-01-01

    OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression. RESULTS: Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications. CONCLUSIONS: In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism. PMID:23778403

  20. Unusual Development of Pulmonary Tumor Embolism from Controlled Liver Metastases of Transitional Cell Carcinoma: An Autopsy Case.

    PubMed

    Kitayama, Hiromitsu; Yokota, Taro; Kondo, Tomohiro; Sugiyama, Junko; Hirayama, Michiaki; Oyamada, Yumiko; Tsuji, Yasushi

    2016-01-01

    Clinicians generally suspect pulmonary tumor embolism (PTE) with uncontrolled carcinomas which often spread to lungs. We, however, experienced an autopsy case of diffuse microscopic PTE despite controlled liver metastases of transitional cell carcinoma (TCC). A 66-year-old man with progressing respiratory symptoms showed almost normal chest findings on computed tomography. Although liver metastases were successfully shrunk by chemotherapy, the patient died from aggressive respiratory failure. An autopsy revealed small pulmonary vessels showing diffuse tumor emboli. TCC can cause PTE even if liver metastases are controlled. We must therefore be aware that PTE can manifest as respiratory symptoms without any computed tomography findings. PMID:27580549

  1. Medical Student Attitudes to the Autopsy and Its Utility in Medical Education: A Brief Qualitative Study at One UK Medical School

    ERIC Educational Resources Information Center

    Bamber, Andrew R.; Quince, Thelma A.; Barclay, Stephen I. G.; Clark, John D. A.; Siklos, Paul W. L.; Wood, Diana F.

    2014-01-01

    Attending postmortems enables students to learn anatomy and pathology within a clinical context, provides insights into effects of treatment and introduces the reality that patients die. Rates of clinical autopsies have declined and medical schools have cut obligatory autopsy sessions from their curricula making it difficult to assess medical…

  2. Suicidal hanging: fatalities in Istanbul retrospective analysis of 761 autopsy cases.

    PubMed

    Uzün, Ibrahim; Büyük, Yalçin; Gürpinar, Kağan

    2007-10-01

    We retrospectively analyzed the autopsy records of the Institute of Forensic Medicine during the five-year period between 1998 and 2002 to document the characteristics of fatalities resulting from hanging which is the commonest mode of suicide in Istanbul. Upon analysis of death scene investigation and autopsy reports together with the information gathered from the police, the cases of hanging fatalities of suicidal origin were selected. Seven hundred sixty one hanging cases of suicidal origin were detected and evaluated in terms of demographic features, the type of hanging material used for ligature, cause of death, internal findings in neck organs, other traumatic findings suggesting the use of another method for suicide, toxicological findings and microscopic findings in delayed death cases. In 364 of these cases suspension was complete and in 397 incomplete. Five hundred thirty seven of those (70.56%) were male and 224 (29.44%) were female. The preponderance of male cases in our autopsy population was also detected in suicidal hanging cases. There was no case aged lower 10 and the number of the cases in the age group of cases aged over 80 was the lowest (n=3, 0.4%). In 634 of cases, the place of hanging was the subject's own house, most victims selected rope (652 cases) for the ligature with the rest using sheet, belt, cable and necktie. There were traumatic findings showing attempts of suicide other than hanging in 24 cases (tentative marks in 22 cases and non-fatal burning in 2). In 23 of cases, there were bruises of different ages. In these cases females constituted the majority suggesting violence against women that is a social problem in various cultural subgroups of our country. This violence may have played a role in the decision of suicide. Superficial bruises were detected in 56 cases and were attributed to the trauma. Fractures in neck organs were detected in 446 of cases. In fracture-determined cases, fracture in hyoid bone was seen in 177, in

  3. Verbal Autopsy: Evaluation of Methods to Certify Causes of Death in Uganda.

    PubMed

    Mpimbaza, Arthur; Filler, Scott; Katureebe, Agaba; Quick, Linda; Chandramohan, Daniel; Staedke, Sarah G

    2015-01-01

    To assess different methods for determining cause of death from verbal autopsy (VA) questionnaire data, the intra-rater reliability of Physician-Certified Verbal Autopsy (PCVA) and the accuracy of PCVA, expert-derived (non-hierarchical) and data-driven (hierarchal) algorithms were assessed for determining common causes of death in Ugandan children. A verbal autopsy validation study was conducted from 2008-2009 in three different sites in Uganda. The dataset included 104 neonatal deaths (0-27 days) and 615 childhood deaths (1-59 months) with the cause(s) of death classified by PCVA and physician review of hospital medical records (the 'reference standard'). Of the original 719 questionnaires, 141 (20%) were selected for a second review by the same physicians; the repeat cause(s) of death were compared to the original,and agreement assessed using the Kappa statistic.Physician reviewers' refined non-hierarchical algorithms for common causes of death from existing expert algorithms, from which, hierarchal algorithms were developed. The accuracy of PCVA, non-hierarchical, and hierarchical algorithms for determining cause(s) of death from all 719 VA questionnaires was determined using the reference standard. Overall, intra-rater repeatability was high (83% agreement, Kappa 0.79 [95% CI 0.76-0.82]). PCVA performed well, with high specificity for determining cause of neonatal (>67%), and childhood (>83%) deaths, resulting in fairly accurate cause-specific mortality fraction (CSMF) estimates. For most causes of death in children, non-hierarchical algorithms had higher sensitivity, but correspondingly lower specificity, than PCVA and hierarchical algorithms, resulting in inaccurate CSMF estimates. Hierarchical algorithms were specific for most causes of death, and CSMF estimates were comparable to the reference standard and PCVA. Inter-rater reliability of PCVA was high, and overall PCVA performed well. Hierarchical algorithms performed better than non

  4. Verbal Autopsy: Evaluation of Methods to Certify Causes of Death in Uganda

    PubMed Central

    Mpimbaza, Arthur; Filler, Scott; Katureebe, Agaba; Quick, Linda; Chandramohan, Daniel; Staedke, Sarah G.

    2015-01-01

    To assess different methods for determining cause of death from verbal autopsy (VA) questionnaire data, the intra-rater reliability of Physician-Certified Verbal Autopsy (PCVA) and the accuracy of PCVA, expert-derived (non-hierarchical) and data-driven (hierarchal) algorithms were assessed for determining common causes of death in Ugandan children. A verbal autopsy validation study was conducted from 2008-2009 in three different sites in Uganda. The dataset included 104 neonatal deaths (0-27 days) and 615 childhood deaths (1-59 months) with the cause(s) of death classified by PCVA and physician review of hospital medical records (the ‘reference standard’). Of the original 719 questionnaires, 141 (20%) were selected for a second review by the same physicians; the repeat cause(s) of death were compared to the original,and agreement assessed using the Kappa statistic.Physician reviewers’ refined non-hierarchical algorithms for common causes of death from existing expert algorithms, from which, hierarchal algorithms were developed. The accuracy of PCVA, non-hierarchical, and hierarchical algorithms for determining cause(s) of death from all 719 VA questionnaires was determined using the reference standard. Overall, intra-rater repeatability was high (83% agreement, Kappa 0.79 [95% CI 0.76-0.82]). PCVA performed well, with high specificity for determining cause of neonatal (>67%), and childhood (>83%) deaths, resulting in fairly accurate cause-specific mortality fraction (CSMF) estimates. For most causes of death in children, non-hierarchical algorithms had higher sensitivity, but correspondingly lower specificity, than PCVA and hierarchical algorithms, resulting in inaccurate CSMF estimates. Hierarchical algorithms were specific for most causes of death, and CSMF estimates were comparable to the reference standard and PCVA. Inter-rater reliability of PCVA was high, and overall PCVA performed well. Hierarchical algorithms performed better than non

  5. Cardiac dilatation index as an indicator of terminal central congestion evaluated using postmortem CT and forensic autopsy data.

    PubMed

    Michiue, Tomomi; Sogawa, Nozomi; Ishikawa, Takaki; Maeda, Hitoshi

    2016-06-01

    Previous studies demonstrated possible application of postmortem quantitative CT data analysis of the heart and lung in situ to investigate terminal cardiopulmonary pathophysiology. The present study analyzed virtual CT morphometric and autopsy data of the heart to investigate terminal central congestion in forensic autopsy cases (n=113, within 3 days postmortem); the virtual total heart weight in situ was estimated using CT morphometry, and the difference from and ratio to the measured weight at autopsy were calculated as indicators of heart blood pooling and the cardiac dilatation index (CDI) before dissection, respectively. There were substantial differences between the estimated heart blood pooling in situ and volume recovered at autopsy, including a characteristic decrease in drowning, alcohol/sedative-hypnotic intoxication and sudden cardiac death (SCD), possibly due to blood redistribution after thoracic dissection. The estimated in situ heart blood pool and CDI values were higher in SCD but lower in fatal hemorrhage and hemopericardium, as well as in acute mechanical asphyxiation and hyperthermia (heatstroke). In addition, there was a significant difference in heart blood pooling between mechanical asphyxiation or drowning and SCD. The CDI was significantly lower in fatal hyperthermia (heatstroke) than in drowning, fatal methamphetamine abuse, alcohol/sedative-hypnotic intoxication and SCD. These findings suggest the usefulness of applying the CDI and postmortem heart blood volume in situ as supplementary indicators of terminal central congestion, especially for investigating deaths from hemorrhage, hemopericardium, hyperthermia (heatstroke) and SCD. PMID:27115507

  6. What Does Psychological Autopsy Study Tell Us about Charcoal Burning Suicide--A New and Contagious Method in Asia?

    ERIC Educational Resources Information Center

    Chan, Sandra S. M.; Chiu, Helen F. K.; Chen, Eric Y. H.; Chan, Wincy S. C.; Wong, Paul W. C.; Chan, Cecilia L. W.; Law, Y. W.; Yip, Paul S. F.

    2009-01-01

    Charcoal burning suicides in Hong Kong between 2002-2004 in the 15 to 59-year-old age group were investigated using the psychological autopsy method. The psychopathological profiles of charcoal burning suicides (N = 53) were compared against "other suicides" (N = 97). The two groups did not differ significantly in the prevalence of "DSM-IV" axis I…

  7. Familial idiopathic basal ganglia calcification: Histopathologic features of an autopsied patient with an SLC20A2 mutation.

    PubMed

    Kimura, Tadashi; Miura, Takeshi; Aoki, Kenju; Saito, Shoji; Hondo, Hiroaki; Konno, Takuya; Uchiyama, Akio; Ikeuchi, Takeshi; Takahashi, Hitoshi; Kakita, Akiyoshi

    2016-08-01

    Idiopathic basal ganglia calcification (IBGC), or Fahr's disease, is a neurological disorder characterized by widespread calcification in the brain. Recently, several causative genes have been identified, but the histopathologic features of the brain lesions and expression of the gene products remain unclear. Here, we report the clinical and autopsy features of a 62-year-old Japanese man with familial IBGC, in whom an SLC20A2 mutation was identified. The patient developed mild cognitive impairment and parkinsonism. A brain CT scan demonstrated abnormal calcification in the bilateral basal ganglia, thalami and cerebellum. An MRI study at this point revealed glioblastoma, and the patient died 6 months later. At autopsy, symmetric calcification in the basal ganglia, thalami, cerebellar white matter and deeper layers of the cerebral cortex was evident. The calcification was observed in the tunica media of small arteries, arterioles and capillaries, but not in veins. Immunohistochemistry using an antibody against type III sodium-dependent phosphate transporter 2 (PiT-2), the SLC20A2 product, demonstrated that astrocytic processes were labeled in several regions in control brains, whereas in the patient, reactivity in astrocytes was apparently weak. Immunoblotting demonstrated a marked decrease of PiT-2 in the patient. There are few autopsy reports of IBGC patients with confirmation of the genetic background. The autopsy features seem informative for better understanding the histogenesis of IBGC lesions. PMID:26635128

  8. Sirenomelia with associated systemic anomalies: an autopsy pathologic illustration of a series of four cases.

    PubMed

    Chikkannaiah, Panduranga; Mahadevan, Anita; Gosavi, Manasi; Kangle, Ranjit; Anuradha; Shankar, S K

    2014-07-01

    Sirenomelia, a developmental defect involving the caudal region of the body, is associated with several internal visceral anomalies. We report a detailed spectrum of anomalies in an autopsy study of four fetuses with sirenomelia (gestational ages - 20, 21, 22.4, and 22.5 weeks). Three of the fetuses had single umbilical artery, with genitourinary and gastrointestinal anomalies. Central nervous system anomalies were evident in two of the fetuses, with alobar holoprosencephaly in one and lumbar meningomyelocele in another. The most common gastrointestinal anomaly was blind ended gut (imperforate anus), while esophageal atresia and omphalocele were noted in one case each. Renal hypoplasia was seen in two fetuses, renal agenesis in one and cystic renal dysplasia was noted in one case. Literature regarding pathogenesis of this condition is briefly discussed. PMID:24656289

  9. [Histologic classification of lung cancers and reproducibility of diagnoses based on 10 years' autopsy material].

    PubMed

    Károlyi, P

    1989-06-11

    Reviewing autopsy records of a ten-year period in the Department of Pathology of Szolnok County Hospital 1607 lung cancer cases were detected, in 1213 of which histological reexamination could be performed. The reproducibility of main histological groups was 73.4%, highest of all in small cell lung cancer. The cause of the relatively low reproducibility rate can be first of all the considerably changeable histological appearance and the frequency of transitional forms between terminally differentiated tumor types. One must not even leave lower diagnostic accuracy of frozen sections out of consideration, the basic method of first diagnosis. The light microscopic heterogeneity and transitional histological forms have been analysed in this article. PMID:2671857

  10. [The art of improvising. The practice of medico-legal autopsies in the 19th century].

    PubMed

    Menenteau, Sandra

    2012-01-01

    Murder is perpetrated, suicide is committed and lethal accidents happen everywhere, even in the heart of the French country. In the 19th century, law often appealed to the lights of experts. During criminal investigation, improvisation and men's adaptation were important, although forensic autopsy was official and necessary. Sometimes the magistrates appealed to young people, not used to that kind of reports, who could only remind some bits of the forensic courses they had followed when they were students. As for the specialists, the circumstances often led them to examine--as Baudelaire would say--the "decaying carcass," in a dark and suffocating ruined house, on the kitchen table, and with a simple scapel. PMID:23038869

  11. The relation of antemortem factors to atherosclerosis at autopsy. The Puerto Rico Heart Health Program.

    PubMed Central

    Sorlie, P. D.; Garcia-Palmieri, M. R.; Castillo-Staab, M. I.; Costas, R.; Oalmann, M. C.; Havlik, R.

    1981-01-01

    Among 9824 Puerto Rican men, aged 35-79, participating in a prospective study of cardiovascular risk factors, there were 970 deaths during the period 1965-1977. About 14%, or 139, of these deaths had a protocol autopsy following the procedures of the International Atherosclerosis Project. The percentage of involvement with raised atherosclerotic lesions in the coronary arteries was higher in the urban deceased than in the rural. The coronary heart disease death rate was also found to be higher in urban than in rural men in this population. Serum cholesterol and systolic blood pressure measured from up to 8 years before death were related both to raised lesions in the coronary arteries and in the aorta. Age and previous smoking status were associated with lesions only in the aorta. These results lend support for an etiologic relationship between serum cholesterol and blood pressure and the atherosclerotic process. PMID:7234969

  12. Clinico-pathological analysis of foal diseases from 237 autopsy cases.

    PubMed

    Oikawa, M A; Kamada, M; Yoshihara, T; Kaneko, M; Yoshikawa, T

    1991-09-01

    To elucidate the current status of foal diseases in Japan, clinico-pathological analysis was conducted on 237 foal autopsy cases. As a result, bacterial infection was identified as an important cause of foal death. Most of the bacteria isolated from these cases were ubiquitous, opportunistic, environmental organisms, known to be non-pathogenic to mature animals. Most of cases with bacterial infection were diagnosed as having hypogammaglobulinemia, i.e., failure of passive transfer. In addition, the mean weight of thymuses in foals affected by bacterial infection tended to be lower than that of foals without infection. These findings suggest that the common cause of foal diseases were mainly due to the opportunistic bacterial infections associated with the weakened immune function, serving as precursor to or promotor of infection. PMID:1811113

  13. Suicide on railroad rights-of-way: a psychological autopsy study.

    PubMed

    Berman, Alan L; Sundararaman, Ramya; Price, Andrea; Au, Josephine S

    2014-12-01

    Findings from 55 psychological autopsies of decedents who perished on U.S. railroad rights-of-way between October 1, 2007, and September 30, 2010 are reported. Described are distal, proximal, and contextual factors of risk; understandings of why these suicides occurred on railroad rights-of-way; and opportunities for prevention of similar suicides. International comparisons of suicides on railroad rights-of-way are made to highlight distinct findings regarding U.S. cases. Decedents studied exhibited considerable predisposing risk for suicide, with a high prevalence of severe mental disorders and substance abuse. In addition, a number of acute risk factors were commonly observed, notably suicide ideation, hopelessness, anxiety, and anger. In the context of that acute risk, associated situational variables and a relative absence of protective factors are described. PMID:24946977

  14. (/sup 3/H)muscimol binding sites increased in autopsied brains of chronic schizophrenics

    SciTech Connect

    Hanada, S.; Mita, T.; Nishino, N.; Tanaka, C.

    1987-01-19

    (/sup 3/H)muscimol binding and glutamic acid decarboxylase (GAD) activity in the prefrontal cortex and caudate nucleus of autopsied brains from 19 chronic schizophrenics and 17 control subjects were investigated. In the schizophrenics, saturation analysis with varying concentrations of (/sup 3/H)muscimol revealed an increase in the number GABA/sub A/ receptors, but there was no significant difference in the affinity. In addition, the enhancement of (/sup 3/H)muscimol binding by diazepam was significantly greater in schizophrenics than in controls. GAD activity did not differ between controls and schizophrenics. The possibility that GABAergic mechanisms might play a role in case of chronic schizophrenia should be given further attention.

  15. An autopsy case of acetyl fentanyl intoxication caused by insufflation of 'designer drugs'.

    PubMed

    Takase, Izumi; Koizumi, Takako; Fujimoto, Ihoko; Yanai, Aya; Fujimiya, Tatsuya

    2016-07-01

    We present a fatal case of intoxication due to insufflation of acetyl fentanyl. His blood concentration of acetyl fentanyl was 270ng/mL, and the manner of death was classified as an accident. This is the first report of an autopsy case of acetyl fentanyl delivered by insufflation, rather than intravenous administration. He had been snoring loudly for at least 12h prior to death, and transport to a hospital during this time and treatment with naloxone may have saved his life. In this sense, it can be said that his death was preventable. This case reemphasizes the risk of death associated with drug overdose and the narrow range of acetyl fentanyl between the effective dose (ED50) and lethal dose (LD50). The case should also raise awareness among medical professionals of the effectiveness of naloxone and the need to establish a comprehensive system for toxicological analysis while keeping the possibility of use of 'designer drugs' in mind. PMID:27497332

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

    PubMed

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

    2012-11-01

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

  17. G-CSF-producing malignant pleural mesothelioma: an autopsy case report with literature review.

    PubMed

    Oka, Kuniyuki; Sarashina, Gen; Yonekawa, Nobuo; Watanabe, Osamu; Miyao, Yoshiko; Hashimoto, Toshio; Yatabe, Yasushi

    2012-06-01

    This study reports a 54-year-old man who was a carpenter by occupation. He suffered from left chest and back pain and left pleural effusion. Peripheral blood showed granulocytosis and high serum titers of granulocyte-colony stimulating factor (G-CSF) and CYFRA. He died 20 months later. At autopsy, a pleural tumor located around the left lung and thickening of the pericardium, diaphragm, and esophagus by tumor infiltration was seen. The tumor proliferated in papillary and solid alveolar patterns by neoplastic cells. They were positive for calretinin, D2-40, CK5/6, HBME-1, G-CSF, CK19, and E-cadherin. He was diagnosed with G-CSF-producing epithelioid malignant pleural mesothelioma. PMID:21911431

  18. [An autopsy case of pulmonary tumor thrombotic microangiopathy complicated with interstitial pneumonia and lipoid pneumonia].

    PubMed

    Ota, Kyoko; Matsuyama, Masashi; Kokuho, Nariaki; Masuko, Hironori; Hayashi, Hiroki; Iizuka, Takashi; Hayashibara, Kenji; Saito, Takefumi; Kawabata, Yoshinori

    2009-06-01

    A 67-year-old woman was admitted to our hospital because of progressive dyspnea, cough, bloody sputum, and backache. Chest radiography and CT scans showed bilateral diffuse interstitial shadows, bilateral pleural effusion and dilatation of the pulmonary artery. Echocardiography indicated pulmonary hypertension, and the serum tumor marker levels were elevated. We performed right cardiac catheterization, and withdrew some blood from a pulmonary artery catheter in the wedge position. We confirmed moderate pulmonary hypertension, and adenocarcinoma-like malignant cells were seen in the aspirated blood. The patient died of progressive respiratory failure despite supportive care. In addition to PTTM and lymphangiosis carcinomatosa, autopsy of the right lung revealed interstitial pneumonia and lipoid pneumonia, both of which were not reported before to be associated with PTTM. PMID:19601530

  19. Individual identification of flood victims by DNA polymorphisms and autopsy findings.

    PubMed

    Mannucci, A; Casarino, L; Bruni, G; Lomi, A; De Stefano, F

    1995-01-01

    On September 23rd 1993 Genova was flooded by heavy rainstorms and 4 people disappeared, including an elderly couple. Four days later a partially skeletonized body was found floating near the coast. No visual identification was possible. Autopsy findings were consistent with the medical history of a possible victim. DNA was extracted from a muscle sample and compared to paraffin embedded prostatic gland fragment taken by surgery. A positive identification could be made. On October 11th the body of a decomposed and partially skeletonized female was found. The visual identification was also uncertain and no clinical records were available. A blood sample from the son was obtained for maternal identification by the polymerase chain reaction. PMID:7599100

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

    PubMed Central

    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

  1. [Autopsy case of drowning caused by accidental carbon dioxide intoxication in a hold tank].

    PubMed

    Sato, Hiroaki; Tanaka, Toshiko; Kasai, Kentaro; Kita, Toshiro

    2009-12-01

    A 49-year-old male captain fell and unfortunately died in a hold tank where he had entered to rescue his fainting co-worker on the disposing waste fluid left there. An autopsy revealed that the captain died from drowning in the waste fluid. In order to clarify the cause of their falling in the tank, the gas in the hold tank was analyzed. The concentration of oxygen was 18.86 to 19.31%, carbon dioxide was 7.28 to 9.07% and the other gases, including hydrogen sulfide, were assessed to be under the normal level. It was concluded that the intoxication of carbon dioxide generated from the waste fluid fermentation was the cause of this fatal accident through loss of consciousness. It is necessary to recognize that carbon dioxide is a dangerous and deleterious gas in circumstances where the gas can be produced. PMID:20000009

  2. Autopsy of anaplastic carcinoma of the pancreas producing granulocyte colony-stimulating factor.

    PubMed

    Hayashi, Haruna; Eguchi, Noriaki; Sumimoto, Kyoku; Matsumoto, Kenta; Azakami, Takahiro; Sumida, Tomonori; Tamura, Tadamasa; Sumii, Masaharu; Uraoka, Naohiro; Shimamoto, Fumio

    2016-08-01

    A 50-year-old man presented to a nearby hospital with high fever and anorexia. An abdominal tumor was detected, and he was referred to our hospital. A pancreatic tumor was detected by computed tomography and abdominal ultrasonography. He had high fever, leukocytosis, and high serum granulocyte colony-stimulating factor (G-CSF). We performed a tumor biopsy and histological examination revealed anaplastic carcinoma of the pancreas. Based on the diagnosis, we initiated chemotherapy using gemcitabine plus S-1. However, the tumor rapidly progressed and he deteriorated and died 123 days after admission. As immunohistochemical study showed positive staining for G-CSF in the tumor cell, we diagnosed the tumor producing G-CSF during autopsy. Anaplastic carcinoma of the pancreas producing G-CSF is very rare, with 10 cases, including ours, reported in the literature. PMID:27498938

  3. Suicide and perfectionism: a psychological autopsy study of non-clinical suicides.

    PubMed

    Kiamanesh, Parvin; Dyregrov, Kari; Haavind, Hanne; Dieserud, Gudrun

    2014-01-01

    This study explores suicide in relation to perfectionism among individuals who died by suicide with no history of treatment in mental health care or of suicide attempts. The study is part of an ongoing psychological autopsy study (PA-study). It aimed to produce a phenomenological understanding of the dynamics/processes from perfectionism to suicide among 6 men aged 22 to 58. Interpretative Phenomenological Analysis (IPA) was used to analyze the interview data of 41 key informants. Based on the informants' narratives, it seemed that perfectionism left these men less able to cope with their (self-perceived) inability to meet their high expectations. Four themes emerged from analysis: 1) striving for success; 2) fear of failure; 3) keeping up the façade; and 4) rigidity. The results may be important in the prevention of nonclinical suicides, a group that is particularly difficult to identify, especially if the deceased have been regarded as very successful in many areas. PMID:25304870

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

    PubMed Central

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

    2013-01-01

    Holoprosencephaly (HPE), a disorder which results from a failure of cleavage or the incomplete differentiation of the forebrain structures at various levels or to various degrees, is related to hereditary factors, chromosomal anomalies, cytogenetic abnormalities, and environmental teratogenic factors. We are reporting a case of a multiparous woman who was G3,P3,L2, who delivered a full term foetus with holoprosencephaly and multiple craniofacial anomalies. An autopsy was conducted. Multiple anomalies of the craniofacial bones, which include hypoplasia and synostosis of the frontal bone, anophthalmia, absence of the anterior cranial fossa, hypoplasia of the maxillae, an absent antrum, cleft palate, a central hare lip and arrhinia which includes absence of the nostrils and hypotelorism of the eye placodes, were noted. This case is being reported for its rarity and the available literature was reviewed in this respect. PMID:24086891

  5. Qualitative psychological autopsy interviews on suicide in post-conflict Northern Uganda: the participants' perceptions.

    PubMed

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

    2011-01-01

    Participants' perceptions of psychological autopsy interviews were investigated in post-conflict Northern Uganda. Data were derived out of their responses in the debriefing session after the formal interviews. These responses were subjected to Interpretative Phenomenological Analysis (IPA). The majority of the participants were positive about the interview as reflected in the two broad themes: positivation of the situation through the possibility of helping others and opportunity for personal development through sharing. To some few participants the interview aroused guilt, self-reproach, and anger and reactivated painful memories. As regards suicide postvention, the findings implied that not much has been done to help the bereaved by suicide in this region, and few resources for such efforts are currently available. However, the bereaved are ready to contribute toward the fight against suicide in their communities. Hence, it is argued that a community-based mental health and Primary Health Care approaches should be encouraged in this context. PMID:21928598

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

    PubMed Central

    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, 1889, and June 30, 1987, a set of 2,310 respelling formulas converted 10,200 words into 659 distinct MeSH titles. Results show that respelling formulas can be used to translate medical natural language into MeSH titles, and thus improve the access to the database.

  7. Enrollment of sudden cardiac death victims into a limited cardiac autopsy study in the emergency department.

    PubMed Central

    Denninghoff, K. R.

    2000-01-01

    The lack of balanced recruitment for racial and ethnic groups in research protocols is an important ethical issue. African Americans have a history of forced participation, unethical research, and unwilling human dissection/demonstration that leads to a lack of participation in clinical research. We have embarked on a study of the pathophysiology of sudden death among African Americans which requires a limited autopsy of the heart. Our objective was to improve the recruitment rate in this study when compared with historical rates seen in clinical research and organ donation. We have screened 14 and enrolled 10 African Americans with sudden death (95% CI 0.41-0.91). By addressing the concerns of the African-American community and involving qualified input in the planning stages of the study we have been able to significantly improve the recruitment rate for this important population subgroup. PMID:10800285

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

    PubMed

    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

  9. Advanced chronic lymphoid leukemia with severe bronchopneumonia: an Autopsy Case Report

    PubMed Central

    Amaral, Felipe Gomes Campos; Lima, Luiz Guilherme Cernaglia Aureliano; Hatanaka, Veruska Menegatti Anastacio; Siqueira, Sheila Aparecida Coelho

    2016-01-01

    Chronic lymphocytic leukemia (CLL) is a lymphoid neoplasia with the B immunophenotype, which corresponds to the leukemic form of lymphocytic lymphoma. This entity is characterized, in most cases, by immunosuppression due to impaired function of immune cells, hypogammaglobulinemia, bone marrow infiltration, and immune dysfunction due to the neoplasia and the chemotherapy, when prescribed. We describe the case of a 63-year-old woman with a previous diagnosis of advanced CLL, refractory to treatment, who presented respiratory failure at the emergency department and died soon after hospital admission. The autopsy examination showed a large retroperitoneal mass compressing large vessels and abdominal and pelvic organs; generalized lymphadenopathy; and liver, spleen, bone marrow, heart and kidney infiltration. A Gram-negative bacilli bronchopneumonia with diffuse alveolar damage was detected, which was likely to be the immediate cause of death. PMID:27284536

  10. Medico-legal autopsy of abandoned foetuses and newborns in India.

    PubMed

    Behera, C; Sikary, Asit Kumar; Krishna, Karthik; Garg, Aayushi; Chopra, Saurav; Gupta, S K

    2016-06-01

    Foeticide and the abandonment of newborns are important, albeit frequently neglected, issues. Concealment of childbirth is often seen in the setting of unwanted pregnancy which has been recognised as one of the most important factors in both cases. This study highlights the medico-legal autopsy findings of 238 abandoned foetuses and newborns over a period of 17 years (1996-2012) from the region of South Delhi, India. There was no sex predilection. The majority of the cases were full term. Nearly 35% of the foetuses were still born, about 29% were live born and the remainder were non-viable. Among the live born, death by homicide was more common than a natural death and most were left by the roadside. The abandoning and killing of newborns needs urgent attention, and strict measures are needed to save thousands of innocent lives. PMID:26857075

  11. Fetal Alcohol Syndrome in Sudden Unexpected Death in Infancy: A Case Report in Medicolegal Autopsy.

    PubMed

    Tangsermkijsakul, Aphinan

    2016-03-01

    Fetal alcohol spectrum disorder is a range of birth defects associated with prenatal alcohol exposure. Fetal alcohol syndrome (FAS) is the most serious form of fetal alcohol spectrum disorder. Infants with FAS are prone to death because of various physical abnormalities. Consequently, infants with FAS may be presented in the medicolegal investigation as a form of sudden unexpected death in infancy. The author reported a 6-month-old male infant who was found dead at home. The history of maternal ethanol consumption during pregnancy was obtained. The infant was diagnosed with FAS at the autopsy because he was presented with postnatal growth retardation, multiple facial abnormalities, and abnormal brain structures, which met the criteria of FAS. The cause of death was severe aspiration pneumonia. The purposes of this case report are to show an uncommon manifestation of sudden unexpected death in infancy case for the forensic pathologists and to emphasize on the national healthcare problem. PMID:26730801

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

    PubMed Central

    Schrader, Kerstin; Nguyen-Dobinsky, Trong-Nghia; Kayser, Klaus; Schrader, Thomas

    2006-01-01

    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

  13. An autopsy case of death due to metabolic acidosis after citric acid ingestion.

    PubMed

    Ikeda, Tomoya; Usui, Akihito; Matsumura, Takashi; Aramaki, Tomomi; Hosoya, Tadashi; Igari, Yui; Ohuchi, Tsukasa; Hayashizaki, Yoshie; Usui, Kiyotaka; Funayama, Masato

    2015-11-01

    A man in his 40s was found unconscious on a sofa in a communal residence for people with various disabilities. He appeared to have drunk 800 ml of undiluted citric acid from a commercial plastic bottle. The instructions on the label of the beverage specified that the beverage be diluted 20- to 30-fold before consumption. The patient was admitted to an emergency hospital with severe metabolic acidosis (pH, 6.70; HCO3(-), 3.6 mEq/L) and a low ionized calcium level (0.73 mmol/L). Although ionized calcium and catecholamines were continuously administered intravenously to correct the acidosis, the state of acidemia and low blood pressure did not improve, and he died 20 h later. Citric acid concentrations in the patient's serum drawn shortly after treatment in the hospital and from the heart at autopsy were 80.6 mg/ml and 39.8 mg/dl, respectively (normal range: 1.3-2.6 mg/dl). Autopsy revealed black discoloration of the mucosal surface of the esophagus. Microscopically, degenerated epithelium and neutrophilic infiltration in the muscle layer were observed. In daily life, drinking a large amount of concentrated citric acid beverage is rare as a cause of lethal poisoning. However, persons with mental disorders such as dementia may mistakenly drink detergent or concentrated fluids, as in our case. Family members or facility staff in the home or nursing facility must bear in mind that they should not leave such bottles in places where they are easily accessible to mentally handicapped persons. PMID:26594004

  14. Saccade abnormalities in autopsy-confirmed frontotemporal lobar degeneration and Alzheimer’s disease

    PubMed Central

    Boxer, Adam L.; Garbutt, Siobhan; Seeley, William W.; Jafari, Aria; Heuer, Hilary W.; Mirsky, Jacob; Hellmuth, Joanna; Trojanowski, John Q.; Huang, Erik; DeArmond, Steven; Neuhaus, John; Miller, Bruce L.

    2012-01-01

    Objective Deficits in the generation and control of saccades have been described in clinically-defined frontotemporal dementia (FTD) and Alzheimer’s disease (AD). Because clinical FTD syndromes can correspond to a number of different underlying neuropathologic FTD and non-FTD diagnoses, we sought to determine the saccade abnormalities associated with autopsy-defined cases of FTLD and AD. Participants and design An infrared eye tracker was used to record visually guided saccades to ten degree targets and antisaccades in 28 autopsy-confirmed FTD and 10 AD subjects, an average of 35.6 ± 10 months prior to death and 27 age-matched normal controls (NC). 12 FTD subjects had FTLD-TDP pathology, 15 had FTLD-tau pathology and one showed FTLD-FUS pathology. Receiver operating curve (ROC) statistics were used to determine diagnostic value of oculomotor variables. Neuroanatomical correlates of oculomotor abnormalities were investigated using voxel-based morphometry (VBM). Results All FTD and AD subjects were impaired relative to NC on the antisaccade task. However, only FTLD-tau and AD cases displayed reflexive visually-guided saccade abnormalities. AD cases displayed prominent increases in horizontal saccade latency that differentiated them from FTD cases. Impairments in velocity and gain were most severe in individuals with Progressive Supranuclear Palsy (PSP) but were also present in other tauopathies. Vertical and horizontal saccade velocity and gain were able to differentiate PSP cases from other patients. Vertical saccade velocity was strongly correlated with dorsal midbrain volume. Conclusion Decreased visually-guided saccade velocity and gain are suggestive of underlying tau pathology in FTD, with vertical saccade abnormalities most diagnostic of PSP. PMID:22491196

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

    PubMed

    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

  16. Trends in autopsy-verified dementia prevalence over 29 years of the Hisayama study.

    PubMed

    Honda, Hiroyuki; Sasaki, Kensuke; Hamasaki, Hideomi; Shijo, Masahiro; Koyama, Sachiko; Ohara, Tomoyuki; Ninomiya, Toshiharu; Kiyohara, Yutaka; Suzuki, Satoshi O; Iwaki, Toru

    2016-08-01

    We investigated the trends in dementia over the past 29 years in the town of Hisayama, Japan using 1266 autopsy specimens. The Hisayama study is a prospective cohort study of lifestyle-related diseases that was started in 1961. Clinical examination of dementia was started in 1985 with five detailed cross-sectional assessments conducted in 1985, 1992, 1998, 2005 and 2012. To examine the trends in dementia, we divided the 1266 autopsy samples into five groups according to the year of death: I (1986-1991, 257 cases), II (1992-1997, 268 cases), III (1998-2004, 318 cases), IV (2005-2011, 296 cases) and V (2012-2014, 127 cases). The prevalence of all-cause dementia significantly increased over time (28.4% in group I, 22.4% in group II, 32.1% in group III, 30.1% in group IV, 51.2% in group V; P for trend <0.001). A similar trend was observed for Alzheimer's disease (AD) (15.2%, 11.9%, 17.3%, 20.6% and 33.1%, respectively; P for trend <0.001). A significant increasing trend was observed in both men and women. A rapid increase in senile dementia of the NFT type (SD-NFT) in recent years was notable. Vascular dementia was the most common type of dementia in men prior to 2004; however, its prevalence decreased over time. Our study revealed that tauopathies, including AD and SD-NFT, significantly increased in the aged Japanese population over the course of this study. The neuritic plaque pathology of AD was associated with metabolic disorders such as insulin resistance and abnormal lipid metabolism, whereas the risk factors for tau pathology remain unclear. Although aging is considered one of the important risk factors accelerating tau pathology, there could be other risk factors associated with lifestyle diseases. PMID:26989005

  17. Autopsy evaluation of coal mining deaths in the city of Zonguldak, Turkey

    PubMed Central

    Ozer, Erdal; Yilmaz, Riza; Evcuman, Durmus; Yildirim, Ali; Cetin, Ilhan; Kocak, Ugur; Ergen, Kivanc

    2014-01-01

    Background In this study, our aim was to evaluate the fatal occupational accidents that occurred in Zonguldak coal mines between the years 2005–2008. Material/Methods We retrospectively evaluated 42 fatal coal mine occupational accidents in Zonguldak (Turkey) between the years 2005–2008. The forensic records of autopsies referred to the chief prosecutors’ office during 2005–2008 were reviewed retrospectively. There were 42 cases. The cases were evaluated with respect to age, mechanism of injury, body region of wound, cause of death, and legality of the mine. Results Ages of the deceased ranged between 17 and 52 (median: 32.9 yrs). Deaths were mostly in the 21–30 (35.8%), and 31–40 (30.9%) age groups. Only 1 case was younger than 18 years of age. Review of occupational fatalities has revealed that fatal accidents occurred mostly (76.2%) in the private, and fewer (23.8%) in the public mining enterprises. Crime scene investigation findings have demonstrated that of all occupational deaths (total n=42), 27 (64.3%) were due to subsidence, followed by methane gas poisoning (n=6, 14.2%), tram crash (n=3, 7.1%), log falls (n=2, 4.8%), electrocution (n=2, 4.8%), and methane explosion (n=2, 4.8%). Conclusions Despite laws and regulations concerning mining and because of problems in their implementation, Turkey leads the world in work-related accidents, occupational injuries, and deaths. Evaluation of autopsy findings of deaths in fatal occupational accidents occurring in coal mines is quite important in planning to decrease rates of occupational fatalities. PMID:24643126

  18. Association between adiposity and systemic atherosclerosis: a protocol of a cross-sectional autopsy study

    PubMed Central

    Nishizawa, Aline; Suemoto, Claudia Kimie; Farias, Daniela Souza; Campos, Fernanda Marinho; da Silva, Karen Cristina Souza; Cuelho, Anderson; Leite, Renata Elaine Paraízo; Ferretti-Rebustini, Renata Eloah de Lucena; Grinberg, Lea Tenenholz; Farfel, José Marcelo; Jacob-Filho, Wilson; Pasqualucci, Carlos Augusto

    2016-01-01

    Introduction Adiposity has been associated with atherosclerosis in clinical studies. However, few autopsy studies have investigated this association, and they had only examined the coronary artery disease. Moreover, most studies had small sample sizes and were limited to middle-aged or young adults. Our aim is to investigate the association between adiposity and systemic atherosclerosis in an autopsy study. Methods and analysis A sample of 240 deceased with 30 years or more will be evaluated. The sample size was calculated using the lowest correlation coefficient found in previous studies (r=0.109), assuming a power of 90% and α=0.05. We will collect information about sociodemographics, frequency of previous contact of the deceased's next of kin and cardiovascular risk factors. We will measure neck, waist and hip circumferences, weight, height and abdominal subcutaneous tissue thickness, and then we will calculate the body mass index, waist-to-hip ratio, waist-to-height ratio and body shape index. We will also weigh the pericardial and abdominal visceral fat, the heart, and we will measure the left ventricular wall thickness. We will evaluate the presence of myocardial infarction, the degree of atherosclerosis in the aorta, carotid, coronary and cerebral arteries and plaque composition in carotid, coronary and cerebral arteries. For each individual, we will fix arterial and adipose tissue samples in 10% formalin and freeze another adipose tissue sample at −80°C for future studies. Ethics and dissemination Ethical approval was granted by the Ethics Committee of University of Sao Paulo Medical School, Brazil. Results will be submitted for publication in a peer-reviewed journal. PMID:27621828

  19. Prevalence of alcohol-related pathologies at autopsy: Estonian Forensic Study of Alcohol and Premature Death

    PubMed Central

    Tuusov, Jana; Lang, Katrin; Väli, Marika; Pärna, Kersti; Tõnisson, Mailis; Ringmets, Inge; McKee, Martin; Helander, Anders; Leon, David A

    2014-01-01

    Aims Alcohol can induce diverse serious pathologies, yet this complexity may be obscured when alcohol-related deaths are classified according to a single underlying cause. We sought to quantify this issue and its implications for analysing mortality data. Design, Setting and Participants Cross-sectional study included 554 men aged 25–54 in Estonia undergoing forensic autopsy in 2008–09. Measurements Potentially alcohol-related pathologies were identified following macroscopic and histological examination. Alcohol biomarkers levels were determined. For a subset (26%), drinking behaviour was provided by next-of-kin. The Estonian Statistics Office provided underlying cause of death. Findings Most deaths (75%) showed evidence of potentially alcohol-related pathologies, and 32% had pathologies in two or more organs. The liver was most commonly affected [60.5%, 95% confidence interval (CI) = 56.3–64.6] followed by the lungs (18.6%, 95% CI = 15.4–22.1), stomach (17.5%, 95% CI = 14.4–20.9), pancreas (14.1%, 95% CI = 11.3–17.3), heart (4.9%, 95% CI = 3.2–7.0) and oesophagus (1.4%, 95% CI = 0.6–2.8). Only a minority with liver pathology had a second pathology. The number of pathologies correlated with alcohol biomarkers (phosphatidylethanol, gamma-glytamyl transpeptidase in blood, ethylglucuronide, ethylsulphate in urine). Despite the high prevalence of liver pathology, few deaths had alcoholic liver disease specified as the underlying cause. Conclusion The majority of 554 men aged 25–54 undergoing forensic autopsy in Estonia in 2008–09 showed evidence of alcohol-related pathology. However, the recording of deaths by underlying cause failed to capture the scale and nature of alcohol-induced pathologies found. PMID:25066373

  20. A Century of Germinal Matrix Intraventricular Hemorrhage in Autopsied Premature Infants: A Historical Account.

    PubMed

    Hefti, Marco M; Trachtenberg, Felicia L; Haynes, Robin L; Hassett, Catherine; Volpe, Joseph J; Kinney, Hannah C

    2016-01-01

    The care of premature infants in the 20th century is remarkable for technical advances that have dramatically improved survival, but little is known about temporal changes in the neuropathology of the premature infant over this time frame. We hypothesize that the autopsy rate of germinal matrix hemorrhage changed in the 20th century relative to combined influences of clinical interventions that were both harmful and helpful. We examined germinal matrix hemorrhage with intraventricular hemorrhage (GMH-IVH) in 345 premature infants (gestational age 25-36 weeks) autopsied at Boston Children's Hospital from 1914 to 2015. There was a median of 19 cases/decade (range 7-68). Over the course of the study median gestational age decreased from 33 to 27 gestational weeks (P<0.001), and median postnatal survival increased from 2 to 26 days (P=0.02). The incidence of GMH-IVH increased from 4.7% before 1960 to 50.0% from 1975 to 1980, and then decreased to 12.5% after 2005 (P<0.001). The incidence of GMH-IVH increased >3-fold around the time of the introduction of positive pressure ventilation into premature intensive care in the mid-1960s. The increased incidence of GMH-IVH in the 1970s-1980s likely reflects respiratory and hemodynamic imbalances complicating mechanical ventilation. We speculate that the subsequent decreased incidence of GMH-IVH likely reflects stabilization of respiratory function with improvements in ventilators and in ventilator management beginning in the 1970s and the use of surfactant and antenatal steroids in the 1980s. PMID:26372101

  1. Coroner autopsy study of homicides in Rivers State of Nigeria: 11-year review.

    PubMed

    Obiorah, C C; Amakiri, C N

    2014-01-01

    As most developing countries, including Nigeria, grapple with economic crisis, poor human capital development and high levels of income inequality, violent crimes - especially homicides - continue to be a cause for concern. We studied the pathology and demographic distribution of homicides in Rivers State of Nigeria expecting that the findings would be useful in formulating preventive strategies. Reports of homicide autopsies in the state for 11 years were retrospectively scrutinized for age, gender, type of weapon, site of injury, circumstances, mechanisms and causes of death. The data were analyzed using SPSS version 17. Homicides constituted 50.5% of the medicolegal autopsies. Although the overall male:female ratio was 12.4 : 1, there was variation with weapon. Deaths by firearm had the highest male:female ratio of 24.6 : 1. The mean and peak ages were 29.2 ± 11.4 and 21-30 years, respectively, while the range was 1 to 96 years. Firearms were the most common weapons, at 68.9%, hemorrhagic shock and head injuries at 61.5% and 28.2% respectively were the most common mechanisms and causes of death. Armed robbery incidents were the most common circumstances, while the head was the most common site of injury at 48.8%. The homicide rate is high in our environment and most homicides are committed during armed robberies using firearms. Improving medical care and providing emergency medical services will reduce cases of deaths from homicides, most of which occur due to manageable hemorrhagic shock. Increasing the drive towards controlling illegal arms acquisition and possession will reduce the present carnage in the state. PMID:23945261

  2. Prevalence of incidental prostate cancer: A systematic review of autopsy studies.

    PubMed

    Bell, Katy J L; Del Mar, Chris; Wright, Gordon; Dickinson, James; Glasziou, Paul

    2015-10-01

    Prostate cancer screening may detect nonprogressive cancers, leading to overdiagnosis and overtreatment. The potential for overdiagnosis can be assessed from the reservoir of prostate cancer in autopsy studies that report incidental prostate cancer rates in men who died of other causes. We aimed to estimate the age-specific incidental cancer prevalence from all published autopsy studies. We identified eligible studies by searches of Medline and Embase, forward and backward citation searches and contacting authors. We screened the titles and abstracts of all articles; checked the full-text articles for eligibility and extracted clinical and pathology data using standardized forms. We extracted mean cancer prevalence, age-specific cancer prevalence and validity measures and then pooled data from all studies using logistic regression models with random effects. The 29 studies included in the review dated from 1948 to 2013. Incidental cancer was detected in all populations, with no obvious time trends in prevalence. Prostate cancer prevalence increased with each decade of age, OR = 1.7 (1.6-1.8), and was higher in studies that used the Gleason score, OR = 2.0 (1.1-3.7). No other factors were significantly predictive. The estimated mean cancer prevalence increased in a nonlinear fashion from 5% (95% CI: 3-8%) at age <30 years to 59% (95% CI: 48-71%) by age >79 years. There was substantial variation between populations in estimated cancer prevalence. There is a substantial reservoir of incidental prostate cancer which increases with age. The high risk of overdiagnosis limits the usefulness of prostate cancer screening. PMID:25821151

  3. Hereditary leiomyomatosis and renal cell carcinoma (HLRCC): a rapid autopsy report of metastatic renal cell carcinoma.

    PubMed

    Udager, Aaron M; Alva, Ajjai; Chen, Ying-Bei; Siddiqui, Javed; Lagstein, Amir; Tickoo, Satish K; Reuter, Victor E; Chinnaiyian, Arul M; Mehra, Rohit

    2014-04-01

    Rapid ("warm") autopsies of patients with advanced metastatic cancer provide invaluable insight into the natural history, pathobiology, and morphology of advanced and treatment-resistant tumors. Here, we report a rapid autopsy case of a hereditary leiomyomatosis and renal cell carcinoma (HLRCC) patient with advanced metastatic renal cell carcinoma (RCC)-the first such case described for either a primary renal tumor or HLRCC-related cancer. Mutations in the fumarate hydratase (FH) gene underlie HLRCC, a rare syndrome involving cutaneous and uterine leiomyomata and aggressive kidney tumors. Loss of heterozygosity at the wild-type FH gene locus results in profound cellular metabolic derangement, "pseudohypoxic" upregulation of hypoxia-inducible factor 1α (HIF-1α)-dependent transcription, and aberrant protein succination; these molecular changes drive oncogenesis of kidney tumors in HLRCC patients. The current index patient had a high-grade RCC with classic morphologic features of HLRCC, including large nuclei with prominent eosinophilic nucleoli and perinucleolar clearing. In addition, this patient's RCC demonstrated extensive sarcomatoid and rhabdoid features-morphologies not previously well described in HLRCC-associated kidney tumors. Here, we report the extent of metastatic dissemination and supplement this unique tumor morphology with mitochondrial enzyme histochemistry and extended immunohistochemical analysis. Tumor cells strongly expressed PAX8, vimentin, CD10, and the HIF target GLUT1 and showed increased nuclear p53 accumulation; the expression of other RCC markers was negative. We also detail microscopic tubular epithelial changes in the grossly uninvolved ipsilateral renal parenchyma and demonstrate sporadic, aberrant upregulation of the HIF targets GLUT1 and CAIX in dysplastic peritumoral tubules. PMID:24625422

  4. Hereditary leiomyomatosis and renal cell carcinoma (HLRCC): a rapid autopsy report of metastatic renal cell carcinoma

    PubMed Central

    Udager, Aaron M.; Alva, Ajjai; Chen, Ying-Bei; Siddiqui, Javed; Lagstein, Amir; Tickoo, Satish K.; Reuter, Victor E.; Chinnaiyian, Arul M.; Mehra, Rohit

    2014-01-01

    Rapid (“warm”) autopsies of patients with advanced metastatic cancer provide invaluable insight into the natural history, pathobiology, and morphology of advanced and treatment-resistant tumors. Here, we report a rapid autopsy case of a hereditary leiomyomatosis and renal cell carcinoma (HLRCC) patient with advanced metastatic renal cell carcinoma (RCC)—the first such case described for either a primary renal tumor or HLRCC-related cancer. Mutations in the fumarate hydratase (FH) gene underlie HLRCC, a rare syndrome involving cutaneous and uterine leiomyomata and aggressive kidney tumors. Loss of heterozygosity at the wild-type FH gene locus results in profound cellular metabolic derangement, “pseudohypoxic” upregulation of hypoxia-inducible factor 1[alpha] (HIF-1[alpha])-dependent transcription, and aberrant protein succination; these molecular changes drive oncogenesis of kidney tumors in HLRCC patients. The current index patient had a high-grade RCC with classic morphologic features of HLRCC, including large nuclei with prominent eosinophilic nucleoli and perinucleolar clearing. In addition, this patient’s RCC demonstrated extensive sarcomatoid and rhabdoid features—morphologies not previously well described in HLRCC-associated kidney tumors. Here, we report the extent of metastatic dissemination and supplement this unique tumor morphology with mitochondrial enzyme histochemistry and extended immunohistochemical analysis. Tumor cells strongly expressed PAX8, vimentin, CD10, and the HIF target GLUT1 and showed increased nuclear p53 accumulation; the expression of other RCC markers was negative. We also detail microscopic tubular epithelial changes in the grossly uninvolved ipsilateral renal parenchyma and demonstrate sporadic, aberrant upregulation of the HIF targets GLUT1 and CAIX in dysplastic peritumoral tubules. PMID:24625422

  5. Correlation between echocardiographic endocardial surface mapping of abnormal wall motion and pathologic infarct size in autopsied hearts.

    PubMed

    Wilkins, G T; Southern, J F; Choong, C Y; Thomas, J D; Fallon, J T; Guyer, D E; Weyman, A E

    1988-05-01

    We previously developed a cross-sectional echocardiographic technique for quantitatively mapping the endocardial surface of the left ventricle and on which regions of abnormal wall motion can be superimposed in their correct spatial distribution. This endocardial mapping technique (EMT) provides a measure of the left ventricular endocardial surface area (ESA in cm2), the area of abnormal wall motion (AWM in cm2), and the overall percent dysfunction (%AWM) as a measure of the functional "infarct size." To test this approach, we compared the EMT measurements with the actual endocardial surface area (in cm2) and pathologic infarct size (both percent infarct by volume and percent endocardial surface overlying infarct) measured at later autopsy in 20 adults (14 men, six women) ranging in age from 47 to 76 years (mean 64 +/- 9.6 years). The median interval from echocardiographic study to death was 19 days (range 1 to 269 days). Patients were divided into two groups based on the age of their infarcts at the time of death: (1) recent (infarct age less than 14 days; mean age 5.3 +/- 4.6 days) and (2) old (infarct age greater than 6 months; mean age 3.6 +/- 3 years). When the left ventricular endocardial surface area at autopsy was compared with the EMT-derived ESA, a close correlation was found (EMT area = 1.17 X autopsy area + 20.4; r = .94, p = .0001), with the systematic difference in the measurements accounted for by systolic arrest, loss of distending pressure, and specimen shrinkage. The echocardiographic measure of infarct size (%AWM) correlated well with the autopsy percent infarction by volume (%AWM = 1.1 X infarct volume + 5.5; r = .82, p = .0001). Similarly, a good correlation was found for the percent abnormal wall motion and the autopsy percent endocardial surface area overlying infarction (%AWM = 0.89 X infarct area - 0.9; r = .89, p = .0001). When the data were examined in relation to the age of the myocardial infarct, the echocardiographic %AWM appeared to

  6. Immunohistochemistry panel segregates molecular types of hepatocellular carcinoma in Brazilian autopsy cases

    PubMed Central

    Felipe-Silva, Aloísio; Wakamatsu, Alda; dos Santos Cirqueira, Cinthya; Alves, Venâncio Avancini Ferreira

    2016-01-01

    AIM: To assess the distribution of proteins coded by genes reported as relevant for the molecular classification of hepatocellular carcinoma (HCC). METHODS: In this retrospective cross-sectional study, the following clinicopathological data were analyzed in 80 autopsied HCC patients: sex, age, ethnicity, alcohol intake, infection with hepatitis B and/or C virus, infection with human immunodeficiency virus, prior treatment, basic and immediate causes of death, liver weight, presence of cirrhosis, number and size of nodules, gross pattern, histological grade and variants, architectural pattern, invasion of large veins, and presence and location of extrahepatic metastases. The protein products of genes known to be involved in molecular pathogenesis of HCC, including epidermal growth factor receptor (EGFR), MET, keratin 19 (K19), vimentin, beta-catenin, mechanistic target of rapamycin (mTOR), extracellular signaling-related kinase (ERK)1, ERK2, Ki67, cyclin D1, caspase 3 and p53, were detected by immunohistochemistry on tissue microarrays. The expression levels were scored and statistically assessed for correlation with HCC parameters. RESULTS: Infection with hepatitis C virus was identified in 49% of the 80 autopsy patients, cirrhosis in 90%, advanced tumors in 95%, and extrahepatic metastases in 38%. Expression of K19, p53 and ERK1 correlated to high-grade lesions. Expression of ERK1, nuclear beta-catenin, cyclin D1 and ERK2 correlated to higher rates of cell proliferation as determined by Ki67. Expression of MET, EGFR (> 0) and caspase 3 correlated with lower histological grades. Expression of EGFR correlated to that of caspase 3, and overexpression of EGFR (≥ 200/300) was observed in low-grade tumors more frequently (grades 1 and 2: 67% vs grade 3: 27% and grade 4: 30%). Expression of ERK1 was associated with that of K19 and vimentin, whereas expression of ERK2 was associated with that of cyclin D1, MET and membrane beta-catenin. Expression of vimentin was

  7. Autopsy features relevant for discrimination between suicidal and homicidal gunshot injuries.

    PubMed

    Karger, B; Billeb, E; Koops, E; Brinkmann, B

    2002-10-01

    A total of 624 consecutive gunshot autopsies from the Institutes of Legal Medicine in Münster and Hamburg was investigated retrospectively. In a subsample of 284 suicides and 293 homicides (n=577), a large variety of features such as firearm, ammunition, number and site of entrance wounds, shooting distance and direction of the internal bullet path were recorded and binary logistic regression analysis performed in the case of bullet paths. Females constituted 26.3% of the homicide victims and 10.6% of the suicides. Short-barrelled firearms outnumbered long arms in homicides by 6:1 and in suicides by 2:1. More than 1 gunshot injury was found in 5.6% of the suicides (maximum 5 gunshots) and in 53.9% of the homicides (maximum 23 gunshots). The suicidal gunshots were fired from contact or near contact range in 89% while this was the case in only 7.5% of the homicides. The typical entrance wound sites in suicides were the temple (36%), mouth (20%), forehead (11%) and left chest (15%) but uncommon entrance wound sites such as the eye, ear, and back of the neck and head were also encountered. In suicidal gunshots to the right temple (n=107), only 6% of the bullet paths were directed downwards and only 4% were directed from back-to-front. In gunshots to the left chest (n=130), bullet paths running right-to-left or parallel occurred frequently in suicides (75%) and infrequently in homicide victims (19%). From 61 suicides who fired the gun inside their mouth, only 1 pointed the gun downwards. Consequently, some bullet path directions cannot be considered indicative of suicide: downwards and back-to-front in gunshots to the temple, left-to-right in gunshots to the left chest and downwards in mouth shots. The isolated autopsy findings can only be indicative of suicide or homicide but the combined analysis of several findings can be associated with a high probability. PMID:12376836

  8. The importance of hemosiderin deposition in the infant brain: an autopsy study

    PubMed Central

    Türkmen İnanır, N; Eren, F; Akgöz, S; Eren, B; Çetin, S; Gündoğmuş, UN; Çomunoğlu, N; Çomunoğlu, C

    2015-01-01

    Background/aim Iron is an essential element involved in many metabolic processes. Presence and accumulation of iron in various body systems can result in different outcomes. Its accumulation in the central nervous system (CNS) cannot be detected routinely by application of hematoxylin-eosin staining. Detection of the presence of hemosiderin in the brain and cerebellum by application of Perls’ dye is of importance in cases of infant deaths. Material and Methods In this study, brain and cerebellar specimens obtained from 52 eligible infants  (aged 0-1 years) autopsied in our institute between the years 2010 and 2013, independent of the cause of death, were analyzed in order to detect possible presence of hemosiderin. Perls’ dye was used to detect histopathological staining intensity and distribution of hemosiderin in the brain and cerebellum. Results Cases did not differ significantly as for the patients’ age and gender (p =0.473), type of the culprit trauma (p =0.414), death/crime scene (p =0.587), and diagnosis groups (p =0.550). In this autopsy study blue colored hemosiderin granulations, stained with Perls’ dye were detected in the brain (n: 39, 75%), and cerebellum (n: 35, 67.3%). A weakly negative, but significant correlation was detected between the postmortem interval and intensity values of cerebellar hemosiderin (Spearman’s correlation coefficient: -0.381, p =0.024). A statistically significant difference was found between the distribution scores of cerebral hemosiderin in cases with and without trauma history (p =0.03). Median cerebral hemosiderin distribution scores were 2.5 and 2, respectively. Conclusions The detection of a correlation between the presence of cerebral and cerebellar hemosiderin, and postmortem interval in the age group of 0-1 years, should be interpreted as an important finding in the analysis of cerebral iron. The presence of hemosiderin in the CNS may be a significant finding in the elucidation of infant deaths and this

  9. An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features

    PubMed Central

    2014-01-01

    Background Clinical evaluation to differentiate the characteristic features of pulmonary fibrosis and emphysema is often difficult in patients with combined pulmonary fibrosis and emphysema (CPFE), but diagnosis of pulmonary fibrosis is important for evaluating treatment options and the risk of acute exacerbation of interstitial pneumonia of such patients. As far as we know, it is the first report describing a correlation among clinical, radiological, and whole-lung pathological features in an autopsy cases of CPFE patients. Methods Experts retrospectively reviewed the clinical charts and examined chest computed tomography (CT) images and pathological findings of an autopsy series of 22 CPFE patients, and compared these with findings from 8 idiopathic pulmonary fibrosis (IPF) patients and 17 emphysema-alone patients. Results All patients had a history of heavy smoking. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC%) was significantly lower in the emphysema-alone group than the CPFE and IPF-alone groups. The percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%) was significantly lower in the CPFE group than the IPF- and emphysema-alone groups. Usual interstitial pneumonia (UIP) pattern was observed radiologically in 15 (68.2%) CPFE and 8 (100%) IPF-alone patients and was pathologically observed in all patients from both groups. Pathologically thick-cystic lesions involving one or more acini with dense wall fibrosis and occasional fibroblastic foci surrounded by honeycombing and normal alveoli were confirmed by post-mortem observation as thick-walled cystic lesions (TWCLs). Emphysematous destruction and enlargement of membranous and respiratory bronchioles with fibrosis were observed in the TWCLs. The cystic lesions were always larger than the cysts of honeycombing. The prevalence of both radiological and pathological TWCLs was 72.7% among CPFE patients, but no such lesions were observed in patients with IPF or emphysema

  10. Using verbal autopsy to measure causes of death: the comparative performance of existing methods

    PubMed Central

    2014-01-01

    Background Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. Methods We investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, children, neonates and stillbirths, performance was assessed separately for individuals using sensitivity, specificity, Kappa, and chance-corrected concordance (CCC) and for populations using cause specific mortality fraction (CSMF) accuracy, with and without additional diagnostic information from prior contact with health services. A total of 500 train-test splits were used to ensure that results are robust to variation in the underlying cause of death distribution. Results Three automated diagnostic methods, Tariff, SSP, and RF, but not InterVA-4, performed better than physician review in all age groups, study sites, and for the majority of causes of death studied. For adults, CSMF accuracy ranged from 0.764 to 0.770, compared with 0.680 for PCVA and 0.625 for InterVA; CCC varied from 49.2% to 54.1%, compared with 42.2% for PCVA, and 23.8% for InterVA. For children, CSMF accuracy was 0.783 for Tariff, 0.678 for PCVA, and 0.520 for InterVA; CCC was 52.5% for Tariff, 44.5% for PCVA, and 30.3% for InterVA. For neonates, CSMF accuracy was 0.817 for Tariff, 0.719 for PCVA, and 0.629 for InterVA; CCC varied from 47.3% to 50.3% for the three automated methods, 29.3% for PCVA, and 19.4% for InterVA. The method with the highest sensitivity for a specific cause varied by cause. Conclusions Physician review of verbal

  11. Medico-legal autopsies as a source of information to improve patient safety.

    PubMed

    Madea, Burkhard

    2009-04-01

    Clear data on the epidemiology of medical malpractice are missing, at least for Germany. Especially data on the frequency of malpractice claims in penal and civil law are not available. However, from epidemiological and healthcare research some data on the frequency of adverse events (AE), preventable adverse events (PAE) and negligent adverse events (NAE) are available. According to a review of the German Alliance of Patient Safety adverse events can be expected in 5-10%, preventable adverse events in 2-4%, negligent adverse events in about 1% and lethal outcome in about 0.1% of hospitalized patients. However, these data are not compatible with figures from civil and penal law and there seems to be a great "litigation gap". Data on malpractice cases are available from the files of the arbitration committees on medical malpractice, files of liability insurance companies and files of the institutes of forensic medicine. However, these files are not complete and data sources may have some interferences. The arbitration committees are, however, mainly dealing with living patients. Lethal cases are a special subgroup and the best available data source are the files of the institutes of forensic medicine. This subgroup is of special importance since death is the most severe outcome of medical malpractice and the reproach to have caused the death of a patient by medical negligence is the most severe malpractice claim. From a retrospective multicentre study on autopsies performed in cases of medical malpractice claims (altogether 101.358 autopsies, 4450 due to medical malpractice claims) the most important data will be presented (disciplines concerned, cause of accusation, classification of accusation, causes of preliminary proceedings, occupational group and number of approved medical malpractice, outcome of medical malpractice proceedings). However, these data are not only of a descriptive value but have utmost importance also for risk analysis and to increase patient

  12. [On the value of tattoos for identifying unknown bodies - a retrospective study of forensic autopsy cases from Giessen, Germany].

    PubMed

    Birngruber, Christoph G; Görner, Nicole; Ramsthaler, H Frank

    2016-01-01

    The number of tattooed people in Germany has constantly grown over the past few years. The present study deals with the question if this social trend can be seen in foren- sic autopsy cases as well. In a retrospective study, forensic autopsy cases of two periods (1990-1994 and 2010-2014) have been reviewed and statistically analyzed. Comparison of the two periods revealed a significant increase in tattooed individuals, especially in the female subgroup. Between 2010 and 2014, 14.2 % of the deceased showed tattoos. There are significant differences in the frequency and localization of tattoos dependent on age and sex. About 50 % of the tattooed deceased showed tattoos on body sites that are visible for other persons in everyday life. The resulting value of tattoos for the purpose of identifying unknown bodies is discussed and illustrated. PMID:26934763

  13. Changing patterns of infant death over the last 100 years: autopsy experience from a specialist children's hospital

    PubMed Central

    Pryce, JW; Weber, MA; Ashworth, MT; Roberts, SEA; Malone, M; Sebire, NJ

    2012-01-01

    Objectives Infant mortality has undergone a dramatic reduction in the UK over the past century because of improvements in public health policy and medical advances. Postmortem examinations have been performed at Great Ormond Street Hospital for over 100 years, and analysis of cases across this period has been performed to assess changing patterns of infant deaths undergoing autopsy. Design Autopsy reports from 1909 and 2009 were examined. Age, major pathology and cause of death was reviewed from these cases and entered into an anonymized database. A subsequent comparative analysis was performed. Setting All postmortems performed and reported at Great Ormond Street Hospital in 1909 and 2009. Participants Infant deaths, aged 0–365 days, were identified and subsequently analysed for the two years. Main outcome measures Comparative proportional analysis of postmortem findings from the two time periods. Results Three-hundred and fifty-seven and 347 autopsy reports were identified from 1909 and 2009 including 178 and 128 infant deaths, respectively. The commonest cause of death in 1909 was infection (74%) compared to 20% of deaths in 2009. The most frequent final ‘diagnosis’ in 2009 was ‘unexplained sudden unexpected infant death (SUDI)’, despite a full postmortem including ancillary investigations. In contrast, there were no such cases recorded in 1909, but there were frequent deaths due to gastroenteritis and malnutrition together accounting for 16% of cases, compared to one case of gastroenteritis in 2009. Fifteen percent of 1909 cases had infections which are almost never fatal with appropriate treatment in 2009, including tuberculosis, diphtheria and syphilis. Congenital anomalies were detected with similar frequencies at both time points, (21% and 19% in 1909 and 2009, respectively). Conclusion In the UK, significant changes in patterns of pathology have occurred in paediatric autopsy cases performed at a single specialist centre. Fatal infections and

  14. [A clinicopathological investigation of two autopsy cases of calpainopathy (LGMD2A)].

    PubMed

    Hashiguchi, Shuji; Adachi, Katsuhito; Inui, Toshio; Arii, Yoshiharu; Kashiwagi, Setsuko; Saito, Miho; Kagawa, Noriko; Kawai, Hisaomi

    2014-09-01

    In this study, we compared the clinicopathological findings of two autopsy cases of patients with calpainopathy (LGMD2A) from different families. The patient in case 1 was a 72-year-old man with a history of type 2 diabetes mellitus. He exhibited recent memory impairments from the age of 70. ECG revealed an incomplete right bundle branch block. A homozygous frameshift mutation c.1796dupA was found in the CAPN3 gene. Cause of death was respiratory insufficiency and heart failure. The patient in case 2 was a 70-year-old man with a history of hypertension. ECG revealed an incomplete right bundle branch block. A homozygous missense mutation c.1080G>C (p.Trp360Cys) in CAPN3 gene was identified. Cause of death was ischemic cardiomyopathy and systemic circulatory failure. In both cases, muscle pathology revealed severe dystrophic changes. In case 2, cardiac hypertrophy and old myocardial infarcts with stenosis of coronary arteries were observed. Histological examination of the sinoatrial node showed fatty infiltration with ischemic changes in case 2. In both cases, the patients' brains showed cerebral atrophy and well preserved neurons. Calpain 3 abnormality was correlated with skeletal muscle involvement. It should be considered that LGMD2A might be complicated by dysfunction of the cardiac conduction system. PMID:25200581

  15. Portal-systemic shunt encephalopathy presenting with diffuse cerebral white matter lesion: an autopsy case.

    PubMed

    Kimura, Noriyuki; Kumamoto, Toshihide; Hanaoka, Takuya; Nakamura, Kenichiro; Hazama, Yusuke; Arakawa, Ryuki

    2008-12-01

    We report herein an autopsy case of portal-systemic encephalopathy (PSE) presenting with diffuse tissue rarefaction in the cerebral deep white matter. Clinically, the patient showed recurrent episodes of unconsciousness, abnormal behavior and urinary incontinence, as well as flapping tremor. Cognitive impairment and peripheral neuropathy developed following recurrent episodes. Although conventional arterial portography revealed a small portal-systemic collateral vessel of a left gastro-renal venous shunt, abdominal CT and liver biopsy showed no evidence of liver cirrhosis and serum ammonia level showed a mild increase. T2-weighted MRI demonstrated symmetrical signal hyperintensities in the deep white matter. Neuropathological findings showed Alzheimer type II astrocytes in the deep layers of the cerebral cortices and severe tissue rarefaction with no or slight reactive astrocytosis in the subcortical and deep white matter. These white matter changes have been reported infrequently in patients with PSE. The present case suggests that chronic PSE without liver cirrhosis may develop diffuse white matter lesions. PMID:18384515

  16. [An autopsy case of senile dementia with pathological features of Parkinson's disease].

    PubMed

    Oshima, Kenichi; Tsuchiya, Kuniaki; Iritani, Shuji; Niizato, Kazuhiro; Akiyama, Haruhiko; Ikeda, Kenji; Arai, Heii

    2004-07-01

    We report an autopsy case of Parkinson's disease mimicking senile dementia of the Alzheimer type. A Japanese man developed memory disturbance and visual hallucination at age 70. Although he died from pneumonia at age of 74, he had no neurological signs throughout the clinical course. The weight of his brain was 1,420 g. Macroscopic examination of the brain revealed prominent depigmentation of the substantia nigra and locus ceruleus. Histological examination disclosed neuronal loss with astrocytosis and the appearance of the Lewy bodies in the nucleus basalis of Meynert, substantia nigra, locus ceruleus, and dorsal vagal nucleus. There were widespread senile plaques in the brain, including the precentral gyrus, which was compatible with Braak stage C. A small number of neurofibrillary changes were present in the limbic areas, consistent with Braak stage III. This case is consistent with brain stem dominance with the pathological diagnosis of the Consortium on Dementia with Lewy Bodies International Workshop. That is, it is compatible with Parkinson's disease. We postulate that the clinical features of Parkinson's disease are more widespread than previously considered. PMID:15379289

  17. Tissue levels of mercury in autopsy specimens of liver and kidney

    PubMed Central

    Magos, L.; Bakir, F.; Clarkson, T. W.; Al-Jawad, A. M.; Al-Soffi, M. H.

    1976-01-01

    Fifty-one autopsy specimens of liver were analysed for total mercury. Thirteen specimens contained less than 10 mg/kg of mercury, with a minimum value of 1.4 mg/kg, indicating that death in suspected cases was not always due to lethal exposure to methylmercury. The methylmercury concentration in 28 livers was 10-30 mg/kg. Limited additional estimations have shown that 71% of the liver mercury was organic and that the level of mercury in the liver of a 7-month-old fetus was only 25% of that in the liver of the mother. In a patient who died in hospital with a blood mercury level of 4.1 μg/ml, the liver contained 16.5 mg/kg of mercury. Differences between these results and those found in the outbreak of methylmercury poisoning in Japan are discussed. Any extrapolation of tissue mercury levels in relation to the toxic effects of methylmercury must take account of the intensity and duration of exposure. PMID:1086171

  18. Pattern of Brain Atrophy Rates in Autopsy-Confirmed Dementia with Lewy Bodies

    PubMed Central

    Nedelska, Zuzana; Ferman, Tanis J.; Boeve, Bradley F.; Przybelski, Scott A.; Lesnick, Timothy L.; Murray, Melissa E.; Gunter, Jeffrey L.; Senjem, Matthew L.; Vemuri, Prashanti; Smith, Glenn E.; Geda, Yonas E.; Graff-Radford, Jonathan; Knopman, David S.; Petersen, Ronald C.; Parisi, Joseph E.; Dickson, Dennis W.; Jack, Clifford R.; Kantarci, Kejal

    2014-01-01

    Dementia with Lewy bodies (DLB) is characterized by preserved whole brain and medial temporal lobe volumes compared to Alzheimer’s disease dementia (AD) on MRI. However, frequently coexistent AD-type pathology may influence the pattern of regional brain atrophy rates in DLB patients. We investigated the pattern and magnitude of the atrophy rates from two serial MRIs in autopsy-confirmed DLB (n=20) and mixed DLB/AD patients (n=22), compared to AD (n=30) and elderly non-demented controls (n=15), followed antemortem. DLB patients without significant AD-type pathology were characterized by lower global and regional rates of atrophy, similar to controls. The mixed DLB/AD patients displayed greater rates in the whole brain, temporo-parietal cortices, hippocampus and amygdala, and ventricle expansion, similar to AD patients. In the DLB and DLB/AD patients, the atrophy rates correlated with Braak neurofibrillary tangle stage, cognitive decline and progression of motor symptoms. Global and regional atrophy rates are associated with AD-type pathology in DLB, and can be used as biomarkers of AD progression in patients with LB pathology. PMID:25128280

  19. High-resolution molecular genomic autopsy reveals complex sudden unexpected death in epilepsy risk profile.

    PubMed

    Klassen, Tara L; Bomben, Valerie C; Patel, Ankita; Drabek, Janice; Chen, Tim T; Gu, Wenli; Zhang, Feng; Chapman, Kevin; Lupski, James R; Noebels, Jeffrey L; Goldman, A M

    2014-02-01

    Advanced variant detection in genes underlying risk of sudden unexpected death in epilepsy (SUDEP) can uncover extensive epistatic complexity and improve diagnostic accuracy of epilepsy-related mortality. However, the sensitivity and clinical utility of diagnostic panels based solely on established cardiac arrhythmia genes in the molecular autopsy of SUDEP is unknown. We applied the established clinical diagnostic panels, followed by sequencing and a high density copy number variant (CNV) detection array of an additional 253 related ion channel subunit genes to analyze the overall genomic variation in a SUDEP of the 3-year-old proband with severe myoclonic epilepsy of infancy (SMEI). We uncovered complex combinations of single nucleotide polymorphisms and CNVs in genes expressed in both neurocardiac and respiratory control pathways, including SCN1A, KCNA1, RYR3, and HTR2C. Our findings demonstrate the importance of comprehensive high-resolution variant analysis in the assessment of personally relevant SUDEP risk. In this case, the combination of de novo single nucleotide polymorphisms (SNPs) and CNVs in the SCN1A and KCNA1 genes, respectively, is suspected to be the principal risk factor for both epilepsy and premature death. However, consideration of the overall biologically relevant variant complexity with its extensive functional epistatic interactions reveals potential personal risk more accurately. PMID:24372310

  20. A rare autopsy case of traumatic rhabdomyolysis associated with intermittent assault.

    PubMed

    Chiba, Fumiko; Makino, Yohsuke; Motomura, Ayumi; Inokuchi, Go; Ishii, Namiko; Torimitsu, Suguru; Hoshioka, Yumi; Abe, Hiroko; Yamaguchi, Rutsuko; Hashimoto, Mari; Sakuma, Ayaka; Nagasawa, Sayaka; Saito, Hisako; Yajima, Daisuke; Iwase, Hirotaro

    2016-05-01

    Traumatic rhabdomyolysis generally occurs after severe blunt trauma and is acute in onset, associated with severe disease, and potentially lethal. Accordingly, diagnosis of traumatic rhabdomyolysis in patients without massive subcutaneous or intramuscular hemorrhage is difficult, especially in the postmortem period, which is limited in terms of the availability of biochemical examination tools and accurate history of illness. To the best of our knowledge, there are no previous reports of death from traumatic rhabdomyolysis among individuals who did not pursue medical consultation. A previously healthy man in his early sixties had been punched and kicked several times in the previous 2months, but he had not gone to a hospital. He suddenly lost consciousness at his workplace approximately 5days after the most recent assault, and cardiopulmonary arrest occurred when the emergency service arrived. He died the same day, and a medicolegal autopsy was performed. Although several sites of minor subcutaneous and muscle hemorrhage were observed, the cause of death was unclear upon macroscopic assessment. Immunohistochemical staining revealed acute renal failure caused by rhabdomyolysis. We herein report a rare case of fatal traumatic rhabdomyolysis, seemingly associated with minor and apparently nonlethal muscle injury. PMID:27161922

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

    PubMed Central

    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

  2. Death of a president and his assassin--errors in their diagnosis and autopsies.

    PubMed

    Paulson, George

    2006-06-01

    On July 2, 1881, Charles Julius Guiteau shot President James Abram Garfield in the right flank. The President died because of infection produced by the unsterile fingers and probes repeatedly inserted into the wound. The major complaint of the wounded President was intractable pain in his legs and feet. This symptom failed to alert the doctors to the possibility of vertebral and spinal cord injury. Garfield died with sepsis after 80 days of intense national concern, and for the patient there was psychological, physical, and nutritional deprivation. His autopsy revealed the bullet was not in the pelvis as his doctors had expected, but adjacent to the first lumbar vertebra it had shattered. The trial and execution of Guiteau split the medical community into those that considered him insane and those who felt execution was justified. Guiteau was delusional and his brain revealed chronic inflammation and histological features suggestive of syphilis. At the time, and since, the propriety of the execution has been questioned. PMID:16608737

  3. Unemployment as a risk factor for completed suicide: a psychological autopsy study.

    PubMed

    Pompili, Maurizio; Innamorati, Marco; Di Vittorio, Cristina; Baratta, Stefano; Masotti, Vittoria; Badaracco, Annalisa; Wong, Paul; Lester, David; Yip, Paul; Girardi, Paolo; Amore, Mario

    2014-01-01

    This study adopts a psychological autopsy method to compare (1) unemployed suicides, (2) other suicides who were either employed or not in the labor force, and (3) psychiatric outpatients without any prior suicidal behavior. A total of 245 consecutive suicides from Province of Parma (Italy) with recorded employment status were included in the analysis. The control group included 41 psychiatric outpatients aged 18 to 64 years, who had not engaged in any previous suicidal act, and who were unemployed. The unemployed suicides had a risk 17 times higher to have had financial problems in the last 12 months (95% confidence interval [CI]: 2.0/149.5; p < 0.01) than other suicides. Unemployed suicides (compared to living unemployed controls) were 10 times more likely to have had poor social support (95% CI: 1.7/56.1; p < 0.01), 16 times more likely to have had any stressful life events in the past 12 months (95% CI: 2.5/103.9; p < 0.01), and 22 times more likely to have a diagnosis of borderline personality disorder (95% CI: 2.4/203.2; p < 0.01). New suicide prevention strategies for those who are facing job loss need to focus on social support and personality disorders, as well as hopelessness and despair. PMID:24689509

  4. Transjugular Intrahepatic Portosystemic Shunt: Histologic and Immunohistochemical Study of Autopsy Cases

    SciTech Connect

    Terayama, Noboru; Matsui, Osamu; Kadoya, Masumi; Yoshikawa, Jun; Gabata, Toshifumi; Miyayama, Shiro; Takashima, Tsutomu; Kobayashi, Kenichi; Nakanishi, Isao; Nakanuma, Yasuni

    1997-11-15

    Purpose: To assess the histologic findings associated with stenosed and occluded transjugular intrahepatic portosystemic shunt (TIPS) tracts. Methods: Four TIPS tracts within three autopsy livers were histologically studied for vascular components by routine staining and immunohistochemical staining. TIPS had been performed for bleeding from esophageal varices in patients with cirrhosis of the liver. Results: Two TIPS, examined on days 4 and 53, showed occlusion by fibrin thrombus. In the former, no endothelial cells were detected, but coagulative necrosis of hepatocytes was found in the surrounding liver. In the latter, bile pigments were seen on the luminal surface. In the two other TIPS without tract occlusion, examined on days 49 and 293, a layer of endothelial cells, proliferation of smooth muscle cells, and deposition of an extracellular matrix such as collagen were confirmed. In the tract examined on day 293, there was protrusion of hepatocytes into the lumen through the stent wires. Conclusion: Short- and midterm TIPS occlusions were caused by thrombus forming after necrosis of hepatocytes and bile leakage, respectively. Long-term TIPS stenosis was associated with a combination of pseudointimal hyperplasia and ingrowth of hepatocytes.

  5. Interstitial pneumonia induced by sorafenib in a patient with hepatocellular carcinoma: An autopsy case report

    PubMed Central

    YAMAGUCHI, TAKASHI; SEKI, TOSHIHITO; MIYASAKA, CHIKA; INOKUCHI, RYOSUKE; KAWAMURA, RINAKO; SAKAGUCHI, YUUTAKU; MURATA, MIKI; MATSUZAKI, KOICHI; NAKANO, YORIKA; UEMURA, YOSHIKO; OKAZAKI, KAZUICHI

    2015-01-01

    Sorafenib is a multikinase inhibitor currently approved in Japan for the treatment of unresectable hepatocellular carcinoma. Interstitial pneumonia induced by sorafenib may have a fatal outcome, and therefore, has recently been the focus of many studies. The current report presents an autopsy case of diffuse alveolar damage (DAD) that occurred in a 59-year-old male, who had been treated with sorafenib. The patient had been given sorafenib for six months and had exhibited no respiratory symptoms during this time. However, 19 days after sorafenib treatment was resumed, acute interstitial pneumonia developed. In previously reported cases, the first symptoms of pulmonary toxicity appeared following a limited treatment duration with sorafenib; this was in contrast to the patient in the current study, who developed the first symptoms after eight months. We therefore conclude that physicians must be aware of interstitial pneumonia as a potential pulmonary toxicity associated with sorafenib treatment when treatment with sorafenib is resumed, even after prolonged use. In addition, to best of our knowledge, this is the first case of a postmortem examination reported in patient with interstitial pneumonia induced by sorafenib treatment. PMID:25789013

  6. [Benefits of otoscopy in forensic autopsy practice: A prospective study].

    PubMed

    Kučerová, Štěpánka; Hejna, Petr; Dobiáš, Martin

    2016-01-01

    The otoscopy is an examination of the external auditory canal, the eardrum, and the middle ear with an instrument called an otoscope. It is a simple, inexpensive, and time-saving endoscopic method typically used by general practitioners and otorhinolaryngologists. Authors present a prospective study of otoscopic findings investigated consecutively at autopsy. Of the 250 examined persons, 50 positive findings were identified: 38 cases with petechial hemorrhages and 12 cases with tympanic membrane perforation or hemotympanon. Hemorrhages of the tympanic membrane detected through the otoscopy may serve as evidence of congestion within head and neck potentially associated with asphyxiation either in the death or in the living (similar to periorbital and conjuctival petechial hemorrhages). In our study, hemorrhages of the tympanic membrane were related to heart failure, hanging and asphyxiation. Perforated tympanic membrane and hemotympanum have been sporadically reported in victims of fatal lightning strike and rarely in strangulation. This findings were in our study associated with craniocerebral injuries: traffic accidents, falls from height and gunshot injuries. The otoscopy may help to reveal various traumatic and pathological changes within the outer and the middle ear, and, thus, provide important forensic evidence. The otoscopy is also highly recommended in the investigation of the sudden deaths in the young. PMID:27221725

  7. The infantile-onset form of Pompe disease: an autopsy diagnosis

    PubMed Central

    Schultz, Regina

    2015-01-01

    Pompe disease (PD) is a rare, inherited autosomal recessive metabolic disorder caused by the deficiency of the lysosomal acid alpha-glucosidase (GAA) enzyme described in 1932 by the Dutch pathologist Joannes Cassianus Pompe. The prevalence of PD ranges from 1:40,000 to 1:300,000 births and depends on geographic and ethnic factors. Clinical manifestations may vary from a rapidly progressive disabling disease with cardiomegaly, hepatomegaly, weakness, generalized hypotonia, and death within the first year of life, to a mild presentation characterized by slowly progressive myopathy predominantly involving the skeletal muscles. The laboratory diagnostic gold standard is represented by the determination of the alpha-glucosidase activity. However, the muscle histology may also yield the diagnosis by evaluating the tissular glycogen accumulation. Until recently, supportive measures constituted the unique available therapy. Currently, the administration of the recombinant GAA is being used with promising results. The authors present the case of a 5-month-old boy, previously diagnosed with hypertrophic cardiomyopathy since the age of 2 months, who presented acute heart failure accompanied by biventricular dilation followed by refractory shock and death. The autopsy findings confirmed the glycogen-accumulation disease. PMID:26894045

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

    PubMed

    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

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

    PubMed

    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

  10. Verbal autopsy of maternal deaths in two districts of Pakistan--filling information gaps.

    PubMed

    Jafarey, Sadiqua N; Rizvi, Talat; Koblinsky, Marge; Kureshy, Nazo

    2009-04-01

    In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year-2007 (prospective) and the past two years--2005 and 2006-(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death. PMID:19489414

  11. Autopsy study correlating degree of osteoarthritis, synovitis and evidence of articular calcification.

    PubMed

    Gordon, G V; Villanueva, T; Schumacher, H R; Gohel, V

    1984-10-01

    Inflammation has been suggested as a component in the osteoarthritic process. We have examined 150 knees at autopsy to correlate the degree of osteoarthritis (OA) with synovial inflammation, and with radiographic or pathologic evidence of calcification as a possible source of crystal induced inflammation. Roentgenographic evidence of calcification and histologic finding of synovial reaction (proliferation or inflammation) were seen more frequently (p less than .05) in the knees of patients with more advanced OA. Perichondrocytic staining for calcium and phosphorus was seen in 93% of patients with severe OA and in only 24% of those with normal or minimal OA. Calcium hydroxyapatite crystals were identified by electron microscopy in perichondrocytic and other areas in 8 of 15 cartilage samples with moderate to severe OA and in none with normal appearing cartilage. In advanced OA, there were bone fragments embedded in cartilage and synovium. Although the pathogenetic sequences are uncertain, we speculate that calcium hydroxyapatite (and pyrophosphate) crystals and/or bone shards can contribute to both synovitis and cartilage degeneration. PMID:6096542

  12. An autopsy case of familial amyotrophic lateral sclerosis with a TARDBP Q343R mutation.

    PubMed

    Okamoto, Koichi; Fujita, Yukio; Hoshino, Eri; Tamura, Yuhji; Fukuda, Toshio; Hasegawa, Masato; Takatama, Masamitsu

    2015-10-01

    We describe a Japanese autopsy case of familial amyotrophic lateral sclerosis (FALS) with a TARDBP Q343R mutation. This male patient developed dysarthria at the age of 52 years, and bulbar symptoms progressed, with weakness and atrophy in the extremities. His mental status was normal, but he became bedridden, received artificial respiratory support at 54 years of age, and gradually acquired a locked-in state and died at 58 years of age. Microscopically, marked diffuse myelin pallor was observed in the anterolateral columns of the spinal cord. The remaining anterior horn cells contained Bunina bodies and phosphorylation-dependent transactivation response DNA-binding protein of 43 kDa (pTDP-43)-positive neuronal cytoplasmic inclusions (NCIs). Glial cytoplasmic inclusions (GCIs) were also observed. The number of ubiquitin- and p62-positive inclusions was markedly lower than that of pTDP-43-positive inclusions. NCIs and many fine dot-like pTDP-43-positive granules in the neuropil were mainly seen in the temporal and motor cortices, and striatum. NCIs were rare in hippocampal granular cells. Immunoblotting of samples from the cerebral cortex using an anti-pTDP-43 antibody was slightly different from previous TDP-43 pathological subtypes. PMID:26096467

  13. Clinical Findings and Autopsy of a Preterm Infant with Breast Milk-Acquired Cytomegalovirus Infection

    PubMed Central

    Anne-Aurélie, Lopes; Souad, Belhabri; Leila, Karaoui

    2016-01-01

    Background Nonpasteurized, nonfrozen, fresh breast milk from mothers with positive cytomegalovirus (CMV) serology was initially contraindicated to very low-birth-weight infants because of the risk of milk-acquired CMV infection. Recently, the severity of this infection was increasingly discussed and the international guidelines now differ. Since 2012, the American Academy of Pediatrics has recommended nutrition through raw breast milk for all preterm infants. Case We report the case of an infant born prematurely at 27 weeks and 4 days and fed with raw breastmilk from day 12 of life (D12). He presented with a late-onset of CMV infection from D39. The CMV polymerase chain reaction (PCR), negative on D3, was strongly positive on D49, as well as the PCR on breast milk. He had CMV-specific immunoglobulin (Ig) M while his mother had only CMV-specific IgG. On D52, he deteriorated further with septic shock, and a fatal cardiac arrest on D54. His twin presented an asymptomatic CMV infection. The autopsy and histological examination showed evidence of numerous organ damage caused by CMV (with differences compared with congenital infection) but no evidence of bacterial infection. Conclusion Although rare, postnatal CMV infections transmitted by raw breast milk given to very low-birthweight infants can have dramatic consequences. PMID:27257513

  14. Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study.

    PubMed Central

    Baqui, A. H.; Black, R. E.; Arifeen, S. E.; Hill, K.; Mitra, S. N.; al Sabir, A.

    1998-01-01

    While knowledge of causes of deaths is important for health sector planning, little is known from conventional sources about the causes of deaths in Bangladesh. This is partly due to deficiencies in the registration system and partly because few deaths are attended by qualified physicians. The present study was undertaken to update the information available on causes of deaths among under-5-year-olds, taking advantage of advances in verbal autopsy methodology and of the national Bangladesh Demographic and Health Survey conducted in 1993-94. About 25% of the deaths were associated with acute lower respiratory infections (ALRI) and about 20% with diarrhoea. Neonatal tetanus and measles remained important causes of death, and drowning was a major cause for 1-4-year-olds. Research and programmes to enable mothers to identify ALRI cases, particularly pneumonia, and to encourage timely and appropriate care-seeking and strengthening of ALRI case management at the primary care facilities are important priorities. While promotion of oral rehydration for watery diarrhoea and antibiotic treatment for dysentery should continue, broader preventive interventions including provision of safe water and sanitation, and improvements in personal hygiene require more attention. Further intensification of immunization programmes and innovative experimental interventions to reduce childhood from drowning should be designed and tested. PMID:9648357

  15. An autopsy report on a ruptured rudimentary horn (uterine anomaly) with ectopic pregnancy.

    PubMed

    Hirose, Izumi; Harada, Kazuki; Kuroda, Ryohei; Ishii, Yasuhiro; Nakajima, Makoto; Kamei, Yoshimasa; Takazawa, Yutaka; Yoshida, Ken-ichi

    2013-01-10

    The rudimentary horn is a rare developmental anomaly of the Müllerian duct. Ectopic pregnancy in the rudimentary horn is estimated to occur in one out of 76,000-150,000 pregnancies. A 30-year-old primigravida suddenly collapsed after 3 days of continuous abdominal pain. Emergency laparotomy revealed a massive intraperitoneal hemorrhage and fetal demise. The growth of the fetus after 19 weeks of gestation is believed to have caused the rudimentary horn rupture, thereby rapidly leading to hemorrhagic shock in the mother and ischemic death in the fetus. This is the first autopsy report on maternal death due to the rudimentary horn or other Müllerian duct anomalies, which emphasizes the need for forensic pathologists to consider this condition as a possible cause of unexpected death in fertile women. In addition, it is very important for clinicians to detect Müllerian duct anomalies by sonography during routine obstetric examinations, and promptly diagnose anomaly related ectopic pregnancies in women displaying symptoms of an acute abdomen, intraperitoneal hemorrhage, or shock in the emergency practice. PMID:23265443

  16. Polycyclic Aromatic Hydrocarbon Residues in Serum Samples of Autopsied Individuals from Tennessee

    PubMed Central

    Ramesh, Aramandla; Kumar, Anil; Aramandla, Mounika P.; Nyanda, Alfred M.

    2014-01-01

    This study reports the concentrations of Polycyclic Aromatic Hydrocarbons (PAHs) in human blood sera samples (n = 650) obtained at autopsy from individuals who died of drug abuse, alcohol toxicity, homicide, suicide and other unknown causes. The analyzed samples from decedents revealed the presence of PAHs of which B(a)P was the most predominant one, followed by benzo(b)fluoranthene and benzo(k)fluoranthene. The other PAHs detected sporadically and measured were benzo(g,h,i)perylene, acenaphthene, anthracene, phenanthrene, and fluoranthene The mean concentrations of PAHs were greater in the twenties to fifties age groups compared to others. The PAH residue levels detected were high in African Americans compared to Caucasians, Asians, and Hispanics. It appears that environmental exposure, dietary intake and in some cases occupational exposure may have contributed to the PAH body burden. While the PAH residue concentrations measured fall within the range of those reported for healthy adults elsewhere, in isolated cases, the concentrations detected were high, calling the need for a reduction in PAH emissions and human biomonitoring studies for purposes of risk assessment. PMID:25547400

  17. Rubber bullet injury: case report with autopsy observation and literature review.

    PubMed

    Kobayashi, Masahiko; Mellen, Paul F

    2009-09-01

    Rubber bullets are one of the less-lethal (nonlethal) weapons, which are increasingly used to incapacitate dangerous individuals, avoiding use of firearms. An autopsy examination of a man who was shot with improved rubber bullets revealed that the bullet caused pulmonary contusion. The bullet was 30 g in weight and consisted of a sponge foam nose with 40-mm diameter and a plastic body. He was not incapacitated and died of suicidal gunshot wound. The case raised a question as to how severe an injury is necessary to deter a person without causing death. A variety of rubber bullets have been used in the world, and they have occasionally produced severe or lethal injuries. A review of the literature demonstrated that the feature of injuries appeared to be related to the type of missile. It becomes more important for a forensic pathologist to be familiar with rubber bullets and injuries caused by them as the use of less-lethal weapon increases. PMID:19696582

  18. [An autopsied case of pachymeningitis associated with a ruptured, cerebral aneurysm due to Aspergillus infection].

    PubMed

    Nonaka, N; Yamazaki, M; Onishi, Y; Shibuya, H; Okazaki, E

    2001-10-01

    We reported a 64-years-old woman with pachymeningitis associated with a ruptured mycotic cerebral aneurysm due to Aspergillus infection. She had suffered from diabetes mellitus and been treated since she was 49 years old. She complained of headache at the age of 62 and loss of her left visual acuity three months later. She was treated by the pulse therapy of methylprednisolone as neuritis retrobulbaris and her visual acuity recovered. But her headache continued. Three months later, her right visual acuity was lost, and the pulse therapy was not effective this time. Six months later, she died of subarachnoid hemorrhage following acute meningitis. The autopsy was granted, but limited to the cranial cavity. Macroscopically, it disclosed brownish thickened dura around sella turucica involving trigeminal ganglion and optic nerve, and fresh subarachnoid hemorrhage in the basal cisterns and a ruptured aneurysm (3 mm in diameter) between internal carotid and posterior cerebral artery on the left side. Histologically, the brownish thickened dura was infiltrated by lymphocytes, plasma cells, and multinucleated giant cells. The wall around the aneurysm was infiltrated by lymphocytes and plasma cells as well as many fungi. Immunohistochemistry demonstrated the presence of Aspergillus in the thickened dura and the arterial wall around the aneurysm. There were lymphocytes and plasma cell infiltration in the basal subarachnoid space and scattered microabcesses in the brain. Although the first entry of Aspergillus to the dura was unclear, we assume that the final intravascular dissemination of Aspergillus from the dura caused meningitis and mycotic aneurysm. PMID:11993187

  19. An autopsy case of suicide by acetylene explosion: a case report.

    PubMed

    Kashiwagi, Masayuki; Hara, Kenji; Takamoto, Mutsuo; Kageura, Mitsuyoshi; Matsusue, Aya; Sugimura, Tomoko; Kubo, Shin-ichi

    2009-04-01

    We report an autopsy case of a male welder in his thirties who was found dead in an exploded truck cabin. The roof, windows and doors of the cabin had been blown up to 50 metres away. An oxygen cylinder and an acetylene cylinder, both unexploded, were found in the back of the truck. The deceased was lying on the driver's seat. His entire body was burnt, carbonised and partially skeletonised. There was a small amount of soot in his oesophagus and stomach and a large volume of bloody fluid in the trachea and bronchi. There was an extensive haemorrhage in the posterior thoracic wall. No drugs were detected in the blood. Hardly any carbon monoxide and combustion-related gases were detected in the blood, therefore he was not considered to have died from the fire. Acetylene was detected in his blood (21.5 microg/ml in the femoral vein blood) and urine (7.49 microg/ml), with marked haemorrhaging in his back. We therefore concluded that the victim died because of an acetylene explosion in the cabin and also that this was a suicide. PMID:19537452

  20. Infectious cause of death determination using minimally invasive autopsies in developing countries.

    PubMed

    Martínez, Miguel J; Massora, Sergio; Mandomando, Inácio; Ussene, Esperança; Jordao, Dercio; Lovane, Lucilia; Muñoz-Almagro, Carmen; Castillo, Paola; Mayor, Alfredo; Rodriguez, Cristina; Lopez-Villanueva, Miriam; Ismail, Mamudo R; Carrilho, Carla; Lorenzoni, Cesaltina; Lacerda, Marcus V G; Bassat, Quique; Menéndez, Clara; Ordi, Jaume; Vila, Jordi

    2016-01-01

    In developing countries, the knowledge of the microorganisms causing fatal infections is critical and could help designing and implementing more effective preventive interventions and treatment guidelines. We aimed to develop and validate protocols for microbiological analysis in post-mortem samples obtained during minimally invasive autopsy (MIA) procedures and to assess their performance. Thirty MIAs performed in adults at Maputo Central Hospital in Southern Mozambique were included in the analysis. Microbiological tests included a universal screening for HIV, hepatitis B and C viruses, Plasmodium falciparum, and bacterial/fungal culture. In addition, a variety of molecular microbiology assays guided by the histological results were performed in blood, cerebrospinal fluid and a variety of tissue samples including liver, lung and central nervous system. The combination of culture-based methods together with molecular microbiological assays led to the identification of 17 out of 19 (89.5%) of the infectious deaths. Microorganisms identified included Mycobacterium tuberculosis, Toxoplasma gondii, Pneumocystis jiroveci, Cryptococcus neoformans, hepatitis B virus, human herpesvirus 8, cytomegalovirus, Streptococcus pneumoniae, Streptococcus dysgalactiae, Ryzopus oryzae, and Acinetobacter baumannii. The combination of classical cultures, serological tests and molecular assays performed in samples obtained through MIA allows the identification of most infectious agents causing death. PMID:26508103

  1. Medical neglect death due to acute lymphoblastic leukaemia: an autopsy case report.

    PubMed

    Usumoto, Yosuke; Sameshima, Naomi; Tsuji, Akiko; Kudo, Keiko; Nishida, Naoki; Ikeda, Noriaki

    2014-12-01

    We report the case of 2-year-old girl who died of precursor B-cell acute lymphoblastic leukaemia (ALL), the most common cancer in children. She had no remarkable medical history. She was transferred to a hospital because of respiratory distress and died 4 hours after arrival. Two weeks before death, she had a fever of 39 degrees C, which subsided after the administration of a naturopathic herbal remedy. She developed jaundice 1 week before death, and her condition worsened on the day of death. Laboratory test results on admission showed a markedly elevated white blood cell count. Accordingly, the cause of death was suspected to be acute leukaemia. Forensic autopsy revealed the cause of death to be precursor B-cell ALL. With advancements in medical technology, the 5-year survival rate of children with ALL is nearly 90%. However, in this case, the deceased's parents preferred complementary and alternative medicine (i.e., naturopathy) to evidence-based medicine and had not taken her to a hospital for a medical check-up or immunisation since she was an infant. Thus, if she had received routine medical care, she would have a more than 60% chance of being alive 5 years after diagnosis. Therefore, we conclude that the parents should be accused of medical neglect regardless of their motives. PMID:25895240

  2. Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis.

    PubMed

    Muehlenbachs, Atis; Bollweg, Brigid C; Schulz, Thadeus J; Forrester, Joseph D; DeLeon Carnes, Marlene; Molins, Claudia; Ray, Gregory S; Cummings, Peter M; Ritter, Jana M; Blau, Dianna M; Andrew, Thomas A; Prial, Margaret; Ng, Dianna L; Prahlow, Joseph A; Sanders, Jeanine H; Shieh, Wun Ju; Paddock, Christopher D; Schriefer, Martin E; Mead, Paul; Zaki, Sherif R

    2016-05-01

    Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients. These sudden cardiac deaths associated with Lyme carditis occurred from late summer to fall, ages ranged from young adult to late 40s, and four patients were men. Autopsy tissue samples were evaluated by light microscopy, Warthin-Starry stain, immunohistochemistry, and PCR for B. burgdorferi, and immunohistochemistry for complement components C4d and C9, CD3, CD79a, and decorin. Post-mortem blood was tested by serology. Interstitial lymphocytic pancarditis in a relatively characteristic road map distribution was present in all cases. Cardiomyocyte necrosis was minimal, T cells outnumbered B cells, plasma cells were prominent, and mild fibrosis was present. Spirochetes in the cardiac interstitium associated with collagen fibers and co-localized with decorin. Rare spirochetes were seen in the leptomeninges of two cases by immunohistochemistry. Spirochetes were not seen in other organs examined, and joint tissue was not available for evaluation. Although rare, sudden cardiac death caused by Lyme disease might be an under-recognized entity and is characterized by pancarditis and marked tropism of spirochetes for cardiac tissues. PMID:26968341

  3. Laser radiation at various wavelengths for decompression of intervertebral disk. Experimental observations on human autopsy specimens.

    PubMed

    Choy, D S; Altman, P A; Case, R B; Trokel, S L

    1991-06-01

    The interaction of laser radiation with the nucleus pulposus from autopsy specimens of human intervertebral disks was evaluated at different wavelengths (193 nm, 488 nm & 514 nm, 1064 nm, 1318 nm, 2150 nm, 2940 nm, and 10600 nm). A significant correlation of linear least squares fit of the mass ablated as a function of incident energy was found for all lasers used except the Excimer at 193 nm. The 2940-nm Erbium:YAG laser was most efficient in terms of mass of disk ablated per joule in the limited lower range where this wavelength was observed. At higher energy levels, the CO2 laser in the pulsed mode was most efficient. However, the Nd:YAG 1064-nm and 1318-nm lasers are currently best suited for percutaneous laser disk decompression because of the availability of usable waveguides. Carbonization of tissue with the more penetrating Nd:YAG 1064-nm laser increases the efficiency of tissue ablation and makes it comparable to the Nd:YAG 1318-nm laser. PMID:1904334

  4. Cause of death in 1144 patients with diabetes mellitus: an autopsy study.

    PubMed Central

    Joron, G E; Laryea, E; Jaeger, D; Macdonald, L

    1986-01-01

    The pathological reports for all patients over 13 years of age who had had an autopsy at one of three university-affiliated hospitals between 1967 and 1976 were reviewed to determine the principal cause of death. The clinical records of the patients with diabetes were reviewed to verify the diagnosis and to determine the known duration of diabetes. There were 1144 patients with diabetes mellitus and 5674 without. The sex distribution was similar in the two groups. The patients with diabetes were slightly older, males by 2.2 years and females by 3.2 years. Disease of the circulatory system was the principal cause of death in males (53.7%) and females (58.9%) with diabetes. The rates in the corresponding patients without diabetes were 37.6% and 35.2%. Neoplasms accounted for 18.9% of deaths in males with diabetes, compared with 35.7% in males without diabetes; the corresponding figures in females were 16.0% and 39.4%. Renal disease accounted for 5.9% of deaths in patients with diabetes. PMID:3948093

  5. [Legal and technical issues of formalin disposition in association with autopsy].

    PubMed

    Nakajima, M; Yoshida, K

    2001-07-01

    The Ministry of Public Welfare notified on the disposition of formalin, which was used in the histological examination in association with forensic or pathological autopsy. However, those who concerned on the issue had not known exactly how they dispose formalin. The news on the illegal disposition of formalin from our department drew attention to the legal disposition of formalin. These situations led us to investigate the legal and technical aspects of formalin disposition. We examined the legally-described methods such as oxidation, incineration and activated sludge processes and other methods such as formose, supercritical water oxidation, and wet oxidation processes. From legal point of view, we must process poisonous formaldehyde into non-poisonous products under the control of The Poisonous and Peleterious? Substances Control Law. Additionally, the products are under the control of The Sewage Water Law and Water Pollution Control Law, particularly in terms of Biological Oxygen Demand (BOD). After careful investigation, we tentatively conclude that incineration method is the best at present, though the supercritical oxidation and wet oxidation processes may be better in order to cope with the worldwide movement toward the control of environmental hormones and warm climate. PMID:11605419

  6. Motor vehicle-assisted ligature strangulation causing complete decapitation: an autopsy report.

    PubMed

    Samberkar, Prashant Naresh

    2012-03-01

    The victim, a 63-year-old prosperous businessman from Labasa, of the Northern Island (Vanua Levu) of Fiji Islands, was found completely decapitated in the early hours of morning in 2004. Initial police investigation did not reveal any history of any medical or family calamity. Further inquiry by the police revealed that on the previous day the deceased had visited all his friends and relatives, and his behavior was not out of the ordinary. The police suspected it to be a case of homicide. On visit to the scene, a completely decapitated body was found in a van on a downhill road. Tire marks were found on the road. A nylon rope was used for ligature strangulation. At autopsy, the decapitation wound of the head and the torso articulated well. The face was congested, and there was tongue bite. Wound margins were clear-cut, with well-demarcated abrasion and multiple imprints of the nylon rope on the neck. The upper one third of the larynx was attached to the head. No other injuries were found on the body. From the findings, it was obvious that asphyxiation was involved in the death before decapitation. PMID:21455053

  7. Non specific drug distribution in an autopsy case report of fatal caffeine intoxication.

    PubMed

    Ishikawa, Takaki; Yuasa, Isao; Endoh, Minoru

    2015-11-01

    Caffeine has long been recognized as an addictive substance that causes autonomic nerve effect, and is known to increase catecholamine secretion from the adrenal glands. In recent years, the risk of ingesting toxic levels of caffeine has increased because of the easy availability of analgesics, CNS (Central Nervous System) stimulant medicine and dietary supplements at shops, health stores and through online purchases. We report the death of a young female resulting from the ingestion for suicide of an online purchased sleepiness-preventing medicine containing caffeine. The autopsy findings included pulmonary edema and congestion plus cutaneous emphysema. The stomach contents included a dark-brown viscous fluid without tablet or food residue. Toxicological examination revealed the presence of caffeine in the right heart blood (154.2 μg/mL) and stomach contents (197.5 μg/mL) (lethal blood level, >80 μg/mL). The highest caffeine content was in the bile (852.3 μg/mL). Biochemical findings showed that catecholamine concentration in the peripheral blood in the iliac vein was elevated. Immunostaining of catecholamine was weak in the adrenal medulla. We recommend highlighting the toxicity risk of ingesting substances with a high caffeine concentration, and we propose that caffeine concentrations should be included in the comprehensive routine forensic toxicological tests for all cases. PMID:26594005

  8. Immunohistochemical investigation of ubiquitin and myoglobin in the kidney in medicolegal autopsy cases.

    PubMed

    Ishikawa, Takaki; Zhu, Bao-Li; Li, Dong-Ri; Zhao, Dong; Michiue, Tomomi; Maeda, Hitoshi

    2007-09-13

    We examined the immunohistochemical distributions of ubiquitin (Ub) and myoglobin (Mb) in human kidney tissues to assist the pathological assessment of death due to trauma. Medicolegal autopsy cases at our institute (n=138: 0-96 years of age, 105 males and 33 females) were examined. Causes of death were blunt injury (n=31), sharp injury (n=15), poisoning (n=11), drowning (n=10), fire fatalities (n=25), hypothermia (n=7), asphyxiation (n=14), hyperthermia (n=3), and natural diseases (n=22) for controls. Immunostaining of Ub and Mb was performed on the formalin-fixed paraffin-embedded kidney tissue sections. Quantitative analyses by estimating the proportion of Ub- and Mb-positive cells (%positivity) of renal tubule epithelial cells showed that the positivities for Ub and Mb were higher in subjects who died due to fire, blunt injury, sharp injury and fatal hypothermia than in other groups. The Ub-positivity correlated with the severity of airway thermal injury in fire deaths, survival time in blunt injury, and serum markers for renal failure in deaths due to sharp injury. Concomitant increases in the tubular Mb- and Ub-positivities were characteristic to deaths from injury and hypothermia. These findings suggest that Ub may serve as a sensitive indicator of the fatal influence of traumas. PMID:17166680

  9. A study of elderly unnatural deaths in medico-legal autopsies at Lucknow locality.

    PubMed

    Kumar, S; Verma, A K

    2014-07-01

    The main aim of this study was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. Data were collected on 4405 male and female victims of unnatural deaths aged 50 years or more from the total number of 21,235 autopsies performed in King George's Medical University, Lucknow, India over a 5-year period, from 2008 to 2012. There were 3165 male victims and 1240 female victims. Unnatural deaths were higher in rural (64%) than in urban (37%) areas. Accidental deaths were the most common manner of unnatural deaths (59%), followed by suicidal deaths (34%) and homicidal deaths (7%). Traumas were the most common cause of unnatural death (77.3%), followed by undetermined causes (16.6%) and toxicological causes (6.1%). The most common causes of traumatic deaths were blunt head injuries (34%) followed by stab in the chest (6%), burn (16%), blunt injuries in abdomen and chest (10%), firearm injuries in the head and trunk (9%), strangulation (3%), stab in the abdomen (4%), smothering (4%), cut throat (3%), throttling (1%) and hanging (10%). Carbamate poisoning was the most common cause of toxicological deaths (44%) followed by organophosphorous poisoning (33%), ethyl alcohol poisoning (12%), barbiturate poisoning (3%) and zinc phosphide poisoning (8%). PMID:24166690

  10. Autopsy as a tool for learning gross anatomy during 1st year MBBS

    PubMed Central

    Goyal, Parmod Kumar; Gupta, Monika; Kaur, Jaswinder

    2016-01-01

    Introduction: Embalmed cadavers are the primary tool for teaching anatomy. However, difficulties are encountered due to changed color/texture of organs, hardening of tissues, and smell of formaldehyde. To overcome these difficulties, dissections on a fresh human body were shown to the 1st year MBBS students, and their perception was noted. Materials and Methods: After taking universal precautionary measures, postmortem dissections were shown to students on voluntary donated bodies in the dissection hall, in addition to the traditional teaching on embalmed cadavers. Feedback was taken from students and faculty regarding the utility of these sessions. Results: Better appreciation of texture, orientation, location, and relations of organs in fresh body, integration of teaching, awareness of the process and laws related to body donations were the outcomes of the study. However, the smell and sight of blood was felt to be nauseating by some students, and some students were worried about the spread of infectious diseases. Conclusions: Visualizing single fresh body dissection during 1st year professional MBBS is recommended either on medicolegal autopsy or on voluntarily-donated bodies. PMID:27563594

  11. MELAS with diffuse degeneration of the cerebral white matter: report of an autopsy case.

    PubMed

    Yokoyama, Teruo; Hasegawa, Kazuko; Obama, Runko; Ishihara, Tadayuki; Yagishita, Saburou

    2010-02-01

    Up to now diffuse white matter demyelination of the cerebrum has been reported in only a few cases of mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS). Here we document an autopsy case with this rare neuropathology. Most MELAS cases are diagnosed antemortem by A3243G transition of mitochondrial DNA. While cerebral damage including necrotic foci in the cerebral cortex are common findings in MELAS, prominent white matter involvement best characterizes this MELAS case. There were numerous necrotic foci, varying in size and chronological stage, in the cerebral white matter. In the areas of the white matter without necrotic foci, there was diffuse fibrillary gliosis with the loss of axons and oligodendrocytes. The gliosis was dominant in the deep white matter, sparing the U-fiber. The cerebral cortex showed diffuse cortical atrophy with few scattered necrotic foci. Distribution of the cerebral lesions does not coincide with the territory of blood supply. The vascular wall presented only slight to mild hyalinosis. We assumed a common pathogenesis to the cortical lesions and the white matter change. The pathogenesis of the present diffuse cerebral lesions may not be just secondary to circulatory disturbance but partly due to metabolic abnormality. PMID:19496942

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

    SciTech Connect

    Yoshimoto, Yasuhiko; Ezaki, Haruo; Etoh, Ryozo; Hiraoka, Toshio; Akiba, Suminori

    1995-03-01

    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 {le}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 these data. 38 refs., 2 figs., 5 tabs.

  13. Transcriptional profiling and genotyping of degraded nucleic acids from autopsy tissue samples after prolonged formalin fixation times

    PubMed Central

    Ferruelo, Antonio; El-Assar, Mariam; Lorente, José A; Nin, Nicolás; Peñuelas, Oscar; Fernández-Segoviano, Pilar; Gonzalez, Constancio; Esteban, Andrés

    2011-01-01

    Background: Samples used for genotyping and transcription studies are obtained and conserved in very specific conditions. The possibility to use autopsy tissue samples, which contain nucleic acids of very poor quality, would open new possibilities for genetic studies. Methods: We have used liver tissue samples from autopsy cases to (i) determine its quality; (ii) study gene expression of 13 genes involved in different cell processes, before and after cDNA pre-amplification (quantitative reverse transcriptase polymerase chain reaction); and (iii) analyze the presence of 2 common polymorphisms of relevance for illness (ACE I/D genotype by PCR amplification, and TNF-α promoter gene polymorphism, by DNA sequencing). Results: Samples were grouped according to different buffered formalin fixation times (group 1, <15 days; group 2, 60-90 days; group 3, 150-180 days; group 4, 240-270 days). Nucleic acids showed a time-dependent degradation. The expression of 13 genes could be studied in all cases from groups 1 and 2, only 7 from group 3 and none from group 4. cDNA preamplification allowed the study of all genes in all samples. DNA genotyping for ACE and TNF-α promoter region was possible in all cases. Conclusions: We conclude that nucleic acids extracted from autopsy specimens after prolonged periods of time in formalin were of sufficient quality to study gene expression and genotyping using currently available methodology and cDNA pre-amplification. PMID:21326810

  14. Biodistribution Analysis of Oncolytic Adenoviruses in Patient Autopsy Samples Reveals Vascular Transduction of Noninjected Tumors and Tissues.

    PubMed

    Koski, Anniina; Bramante, Simona; Kipar, Anja; Oksanen, Minna; Juhila, Juuso; Vassilev, Lotta; Joensuu, Timo; Kanerva, Anna; Hemminki, Akseli

    2015-10-01

    In clinical trials with oncolytic adenoviruses, there has been no mortality associated with treatment vectors. Likewise, in the Advanced Therapy Access Program (ATAP), where 290 patients were treated with 10 different viruses, no vector-related mortality was observed. However, as the patient population who received adenovirus treatments in ATAP represented heavily pretreated patients, often with very advanced disease, some patients died relatively soon after receiving their virus treatment mandating autopsy to investigate cause of death. Eleven such autopsies were performed and confirmed disease progression as the cause of death in each case. The regulatory requirement for investigating the safety of advanced therapy medical products presented a unique opportunity to study tissue samples collected as a routine part of the autopsies. Oncolytic adenoviral DNA was recovered in a wide range of tissues, including injected and noninjected tumors and various normal tissues, demonstrating the ability of the vector to disseminate through the vascular route. Furthermore, we recovered and cultured viable virus from samples of noninjected brain metastases of an intravenously treated patient, confirming that oncolytic adenovirus can reach tumors through the intravascular route. Data presented here give mechanistic insight into mode of action and biodistribution of oncolytic adenoviruses in cancer patients. PMID:26156245

  15. Autopsy study of febrile deaths during monsoon at a tertiary care institute in India: Is malaria still a challenge?

    PubMed Central

    Gupta, Anurag; Dhume, Varsha; Puranik, Gururaj Venkatesh; Kavishwar, Vikas

    2015-01-01

    Background: To utilise an autopsy-based approach to study the febrile deaths and deaths due to malaria during monsoon period of three years at a tertiary care teaching hospital in Mumbai, India. Materials and Methods: All autopsies done at the hospital during monsoon period from 2005 to 2007 when fever was the main presenting symptom were included in the study. Monsoon period was defined from June to September. A study on the duration of hospital stay of malaria deaths was also attempted. Results: There were 202 autopsies of febrile illness during the study period. Malaria resulted in 20.8% of the deaths besides other causes. A majority of deaths had intrapulmonary haemorrhages as the only pathological finding. Incidence of malaria deaths was more during monsoon period than the non-monsoon period. Plasmodium falciparum was the most common species responsible for malaria deaths while cerebral malaria was the most common mode of death. In 27% of the cases, post-mortem examination helped to arrive at the correct final diagnosis. In 88.1% of the cases, malaria deaths occurred within the first 24 hours of admission to the hospital. Conclusion: The study reiterates the fact that malaria remains a preventable but major cause of death in India, predominantly during the monsoon period. The study also emphasises the importance of developing treatment protocols for malaria during such crucial times besides reinforcing the existing preventive measures. PMID:25657486

  16. “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

    PubMed Central

    Banyini, Audrey V.; Rees, David; Gilbert, Leah

    2013-01-01

    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. PMID:23364088

  17. Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality

    PubMed Central

    2011-01-01

    Background Effective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized instrument exists for collecting and interpreting information on how to avert death and improve the implementation of child survival interventions. Objective To describe the methodology, development, and first results of a standard social autopsy tool for the collection of information to understand common barriers to health care, risky behaviors, and missed opportunities for health intervention in deceased children under 5 years old. Methods Under the INDEPTH Network, a social autopsy working group was formed to reach consensus around a standard social autopsy tool for neonatal and child death. The details around 434 child deaths in Iganga/Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda and 40 child deaths in Dodowa HDSS in Ghana were investigated over 12 to 18 months. Interviews with the caretakers of these children elicited information on what happened before death, including signs and symptoms, contact with health services, details on treatments, and details of doctors. These social autopsies were used to assess the contributions of delays in care seeking and case management to the childhood deaths. Results At least one severe symptom had been recognized prior to death in 96% of the children in Iganga/Mayuge HDSS and in 70% in Dodowa HDSS, yet 32% and 80% of children were first treated at home, respectively. Twenty percent of children in Iganga/Mayuge HDSS and 13% of children in Dodowa HDSS were never taken for care outside the home. In both countries most went to private providers. In Iganga/Mayuge HDSS the main delays were caused by inadequate case management by the health provider, while in Dodowa HDSS the main delays were in the home. Conclusion While delay at home was a main obstacle to prompt and appropriate treatment in

  18. Association of socioeconomic and behavioral factors with adult mortality: analysis of data from verbal autopsy in Addis Ababa, Ethiopia

    PubMed Central

    2013-01-01

    Background Changes in socioeconomic status, lifestyle and behavioral factors among the urban population in Ethiopia is resulting in a shift in the causes of mortality. We used verbal autopsy data from 2006 to 2009 to measure the association of socioeconomic and behavioral factors with causes of mortality in Addis Ababa, Ethiopia. Methods A total of 49,309 deaths from burial surveillance were eligible for verbal autopsy for the years 2006 to 2009. Among these, 10% (4,931) were drawn randomly for verbal autopsy of which 91% (4,494) were adults of age ≥15 years. Verbal autopsies, used to identify causes of death and frequency of risk factors, were completed for 3,709 (83%) of the drawn sample. Results According to the results of the verbal autopsy, non-communicable diseases caused 1,915 (51%) of the total adult deaths, while communicable diseases and injuries caused 1,566 (42%) and 233 (6%) of the deaths respectively. Overall, frequent alcohol (12%) and tobacco consumption (7%) were highly prevalent among the deceased individuals; both because of communicable diseases (HIV/AIDS and tuberculosis) as well as due to non-communicable diseases (malignancy, cardiovascular and chronic liver diseases). HIV/AIDS (AOR = 2.14, 95% CI [1.52-3.00], p < 0.001) and chronic liver diseases (AOR = 3.09, 95% CI [1.95-4.89], p < 0.001) were significantly associated with frequent alcohol consumption, while tuberculosis was associated with both frequent alcohol (AOR = 1.61, 95% CI [1.15-2.24], p = 0.005) and tobacco consumption (AOR = 1.67, 95% CI [1.13-2.47], p < 0.010). Having low educational status, being female and being within the age range of 25 to 44 years were positively associated with HIV/AIDS related mortality. Individuals aged 45 years and above were 3 to 6 times more likely to have died due to cardiovascular diseases compared with those within the 15 to 24 years age group. Conclusion The findings from the analysis suggest that public health

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

    PubMed

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

    2011-01-01

    "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

  20. Human exposure to metals: levels in autopsy tissues of individuals living near a hazardous waste incinerator.

    PubMed

    Mari, Montse; Nadal, Martí; Schuhmacher, Marta; Barbería, Eneko; García, Francisco; Domingo, José L

    2014-06-01

    The concentrations of a number of metals were determined in the brain, bone, kidney, liver, and lung of 20 autopsied subjects who had lived, at least 10 years, in the neighborhood of a hazardous waste incinerator (HWI) in Tarragona (Catalonia, Spain). Results were compared with those obtained in 1998 (baseline survey) and previous surveys (2003 and 2007). Arsenic, Be, Ni, Tl, and V showed concentrations below the corresponding detection limits in all tissues. Cadmium showed the highest levels in the kidney, with a mean value of 21.15 μg/g. However, Cd was found below the detection limit in the brain and bone. Chromium showed similar concentrations in the kidney, brain, and lung (range of mean values, 0.57-0.66 μg/g) and higher in the bone (1.38 μg/g). In turn, Hg was below the detection limit in all tissues with the exception of the kidney, where the mean concentration was 0.15 μg/g (range, <0.05-0.58 μg/g). On the other hand, Mn could be detected in all tissues showing the highest levels in the liver and kidney (1.45 and 1.09 μg/g, respectively). Moreover, Pb showed the highest concentrations in bone (mean, 1.39 μg/g; range, <0.025-4.88 μg/g). Finally, Sn could be detected only in some tissue samples, reaching the highest values in the bone (0.17 μg/g). The current metal levels in human tissues from individuals living near the HWI of Tarragona are comparable and of a similar magnitude to previously reported results corresponding to general populations, as well as those of our previous surveys. PMID:24728924

  1. Subventricular Zone Neural Progenitors from Rapid Brain Autopsies of Elderly Subjects with and without Neurodegenerative Disease

    PubMed Central

    Leonard, Brian W.; Mastroeni, Diego; Grover, Andrew; Liu, Qiang; Yang, Kechun; Gao, Ming; Wu, Jie; Pootrakul, David; van den Berge, Simone A.; Hol, Elly M.; Rogers, Joseph

    2009-01-01

    In mice and young adult humans, the subventricular zone (SVZ) contains multipotent, dividing astrocytes, some of which, when cultured, produce neurospheres that differentiate into neurons and glia. It is unknown whether the SVZ of very old humans has this capacity. Here, we report that neural stem/progenitor cells can also be cultured from rapid autopsy samples of SVZ from elderly human subjects, including patients with age-related neurologic disorders. Histological sections of SVZ from these cases showed a GFAP-positive ribbon of astrocytes similar to the astrocyte ribbon in human periventricular white matter biopsies that is reported to be a rich source of neural progenitors. Cultures of the SVZ contained (1) neurospheres with a core of Musashi-1-, nestin-, and nucleostemin-immunopositive cells, as well as more differentiated GFAP-positive astrocytes; (2) SMI-311-, MAP2a/b-, and β-tubulin (III)-positive neurons; and (3) galactocerebroside-positive oligodendrocytes. Neurospheres continued to generate differentiated progeny for months after primary culturing, in some cases nearly two years post initial plating. Patch clamp studies of differentiated SVZ cells expressing neuron-specific antigens revealed voltage-dependent, tetrodotoxin-sensitive, inward Na+ currents and voltage-dependent, delayed, slowly inactivating K+ currents, electrophysiologic characteristics of neurons. A subpopulation of these cells also exhibited responses consistent with the kinetics and pharmacology of the h current. However, while these cells displayed some aspects of neuronal function, they remained immature, as they did not fire action potentials. These studies suggest that human neural progenitor activity may remain viable throughout much of the life span, even in the face of severe neurodegenerative disease. PMID:19425077

  2. Median ulnar nerves communication in the forearm: a study with autopsy material.

    PubMed

    Ballesteros, Luis E; Forero, Pedro L; Quintero, Iván D

    2014-01-01

    The incidence of median-ulnar communication in the forearm presents variability in different population groups. The aim of this study was to determine the incidence and morphologic expression of the median-ulnar communication in a sample of the Colombian population. One hundred and eight forearms of autopsy material at the National Institute of Forensic Medicine of Bucaramanga, Colombia were studied. Using an approach of the flexor compartment of forearm the median and ulnar nerves were dissected and the communications between these two structures were characterized. The communicating branch occurred in 28 (25.9%) forearms. It occurred unilaterally in 12 specimens and bilaterally in 8, with statistically significant difference (P=0.01). The communication between the anterior interosseous and ulnar nerves was most frequent, observed in 13 (46.4%) forearms. The length of the communicating branch was 56.9 +/- 8.3 mm. The distance of the proximal and distal points of the communicating branch to the bi- epicondylar line was 59.6 +/- 15.4 mm and 102.7 +/- 23.5 mm respectively. The length of the forearm was 269.8 +/- 15.9 mm. A projection of the communicating branch from the upper third to the midthird of the forearm was observed. The incidence of the median-ulnar communication in the present study is in the high rank reported in the literature; there is an agreement with prior studies in finding more numerous communicating branches in the right forearm. The median-ulnar communication should be taken into account for surgical approach of the forearm. PMID:26749683

  3. Evaluation of additional head of biceps brachii: a study with autopsy material.

    PubMed

    Ballesteros, L E; Forero, P L; Buitrago, E R

    2014-05-01

    Additional head of the biceps brachii (AHBB) has been reported in different population groups with a frequency of 1-25%. The purpose of this study was to determine the incidence and morphologic expression of the AHBB as determined in a sample of the Colombian population. An exploration was conducted with 106 arms corresponding to unclaimed corpses autopsied at Institute of Legal and Forensic Medicine of Bucaramanga, Colombia. Using medial incision involvingskin, subcutaneous tissue, and brachial fascia, the heads of the biceps and their innervating branches were visualised. One AHBB was observed in 21 (19.8%) of the arms evaluated, with non-significant difference (p = 0.568) per side of presentation: 11 (52.4%) cases on the right side and 10 (47.6%) on the left side. All AHBBs were originated in the infero-medial segment of the humerus, with a mean thickness of 17.8 ± 6.8 mm. In 4 (19%) cases the fascicle was thin, less than 10 mm; in 7 (33.3%) cases it was of medium thickness, between 11 and 20 mm, whereas in 47.6% it was longer than 20 mm. The length of the AHBB was 118.3 ± 26.8 mm; its motor point supplied by the musculocutaneous nerve was located at 101.3 ± 20.9 mm of the bi-epicondylar line. The incidence of AHBB in this study is located at the upper segment of what has been reportedin the literature and could be a morphologic trait of the Colombian population; in agreement with prior studies, the origin was the infero-medial surface of the humerus. PMID:24902098

  4. Developing a Social Autopsy Tool for Dengue Mortality: A Pilot Study

    PubMed Central

    Arauz, María José; Ridde, Valéry; Hernández, Libia Milena; Charris, Yaneth; Carabali, Mabel; Villar, Luis Ángel

    2015-01-01

    Background Dengue fever is a public health problem in the tropical and sub-tropical world. Dengue cases have grown dramatically in recent years as well as dengue mortality. Colombia has experienced periodic dengue outbreaks with numerous dengue related-deaths, where the Santander department has been particularly affected. Although social determinants of health (SDH) shape health outcomes, including mortality, it is not yet understood how these affect dengue mortality. The aim of this pilot study was to develop and pre-test a social autopsy (SA) tool for dengue mortality. Methods and Findings The tool was developed and pre-tested in three steps. First, dengue fatal cases and ‘near misses’ (those who recovered from dengue complications) definitions were elaborated. Second, a conceptual framework on determinants of dengue mortality was developed to guide the construction of the tool. Lastly, the tool was designed and pre-tested among three relatives of fatal cases and six near misses in 2013 in the metropolitan zone of Bucaramanga. The tool turned out to be practical in the context of dengue mortality in Colombia after some modifications. The tool aims to study the social, individual, and health systems determinants of dengue mortality. The tool is focused on studying the socioeconomic position and the intermediary SDH rather than the socioeconomic and political context. Conclusions The SA tool is based on the scientific literature, a validated conceptual framework, researchers’ and health professionals’ expertise, and a pilot study. It is the first time that a SA tool has been created for the dengue mortality context. Our work furthers the study on SDH and how these are applied to neglected tropical diseases, like dengue. This tool could be integrated in surveillance systems to provide complementary information on the modifiable and avoidable death-related factors and therefore, be able to formulate interventions for dengue mortality reduction. PMID:25658485

  5. Custody and prison deaths autopsied in Istanbul between 2010 and 2012.

    PubMed

    Ünal, Volkan; Özgün Ünal, Esra; Çetinkaya, Zafer; İmalı, Murat; Gürler, Selçuk; Koç, Sermet

    2016-04-01

    The occurred death of a convict in prison, police custody cell or in a hospital always attracts public attention and can be considered as a complex phenomenon. The aim of this study is to evaluate the data obtained from autopsies performed to the custody and prison deaths in Istanbul and to discuss the possible solutions by comparing with the literature. It is also aimed to discuss the postponement of the sentence and presidential amnesty facts in Turkey. Deaths of inmates, which occurred in hospitals, prisons, prison medical rooms, police vans and police custody cells between 2010 and 2012 in Istanbul, Turkey were included in the study. Totally 125 cases were found and 98.4% of them were male. Natural deaths accounted for a great majority of deaths (83.2%). The most common natural cause was cardiovascular diseases. Unnatural deaths accounted for 15.2% of the deaths. Death reason cannot be determined for 1.6% of the cases. More than half of the cases (56%) were died at the hospital, 34.4% were died at the prison, 4% of them at the police van, 3.2% were died under police custody and 2.4% were died at the prison medical room. Moreover, twelve of these cases had applied to Third Specialization Board previously for postponement of the sentence or Presidential amnesty. Totally five of these cases found suitable for postponement of the sentence. Prison conditions should be improved, prisoners with chronic diseases should be examined periodically and if appropriate their sentences should be postponed until they heal. PMID:26807995

  6. Forensic issues in suicidal single gunshot injuries to the chest: an autopsy study.

    PubMed

    Strajina, Veljko; Živković, Vladimir; Nikolić, Slobodan

    2012-12-01

    This study presents a case series of suicides carried out by self-inflicted gunshot wounds to the chest-a relatively uncommon means of suicide. The retrospective autopsy study performed included all cases of single suicidal gunshot injuries to the chest during a 20-year period and which were committed by the use of a handgun. The sample included 67 deceased persons that were an average of 44.4 ± 19.1 years old (range, 12-89 years; 58 men and 9 women). The most common region of the entrance wound was the left side of the chest (54/67), followed by the sternum (10/67), and the right side of the chest (3/67). For 9 subjects, the range of fire could not be determined, as well as whether the shot went through their clothing. In the remaining 58 subjects, only contact or near-contact wounds were found. Of the 58, only 3 subjects had their clothing removed between the chest wall and the muzzle. Three directions of the internal bullet paths were those most frequently found: downward right-to-left (27/67), downward left-to-right (20/67), and downward parallel (10/67) (χ = 101.045, P = 0.000). Also, most bullet paths were directed downward (57/67, χ = 32.970, P = 0.000). The most frequently injured organ was the heart (47/67), and the immediate causes of death were exsanguination (49/67), heart disruption (14/67), and tamponade (4/67). PMID:22354080

  7. Cardiac Findings of Pulmonary Thromboembolism by Autopsy: A Review of 48 Cases

    PubMed Central

    Yakar, Aysun; Yakar, Fatih; Ziyade, Nihan; Yıldız, Muhlis; Üzün, İbrahim

    2016-01-01

    Background To identify the overall effects of pulmonary thromboembolism (PTE) on the heart, we evaluated the heart findings and clinical characteristics of deceased patients diagnosed with PTE. Material/Methods PTEs were classified into 2 categories: fatal and contributory. Cases with a history of cardiopulmonary disease or a finding of significant disease at autopsy, including valvular heart disease and coronary artery obstruction >50%, were excluded from the cardiac evaluation. We defined an LV wall ≥1.2 cm thick and an RV wall ≥0.8 cm thick as abnormal. Results Forty-eight cases were included to the study (21 males and 27 females). The mean age was 41.42±16.5 years. Of the 48 cases, 5 were excluded due to cardiopulmonary diseases for determining heart findings. The thicknesses of the LV and RV walls were not measured in some patients. In the 43 cases, cardiac hypertrophy was detected in 28 patients (65.1%). The mean heart weight was 387±83.5 g. The mean thickness of the left ventricle (LV) wall was 1.40±0.41 cm in 40 cases, and the mean thickness of the RV wall was 0.41±0.135 cm in 41 cases. The LV walls of 35 (87.5%) cases and the RV walls of 2 cases met criteria for abnormal wall thickness. There were histopathological findings of heart in 24/43 cases (56%); these findings were necrosis, fibrosis, and hypertrophy. Conclusions The RV is affected by massive pulmonary embolism; however, the LV may also play a role in the pathogenesis of PTE. PMID:27117720

  8. Aetiology of maternal mortality using verbal autopsy at Sokoto, North-Western Nigeria

    PubMed Central

    Umar, Sadiq

    2013-01-01

    Abstract Background Maternal mortality in developing countries is higher than that in developed countries. There are few published articles on the factors associated with maternal deaths in northern Nigeria. Objectives The objective of this study was to identify the medical causes and factors associated with maternal mortality in Sokoto, northern Nigeria. Method A verbal autopsy questionnaire was used to interview close relatives of women within the reproductive age group who had died of pregnancy-related complications in the Sokoto metropolis during the preceding two years. A multistage sampling method using simple random sampling at each step was used to select areas of study within the Sokoto metropolis. Data analysis was carried out using a statistical package for social sciences (SPSS), version 19, and the Spearman correlation was used to test association. Significance level was set at 0.05. Results The major causes of death were haemorrhage (48.3%), eclampsia (19%) and prolonged labour (13.8%). The association between maternal mortality and the absence of antenatal booking was significant (p < 0.001); the association between maternal mortality and the ‘three delays’ was also significant (p = 0.013). The association between maternal mortality and educational status and occupation was, however, not significant (p = 0.687 and p = 0.427 respectively). Conclusion The medical causes of maternal mortality identified in this study were similar to those of the hospital-based studies in the area. In addition, an association between maternal deaths and the ‘three delays’ and the absence of antenatal booking was found. There is a need for public education efforts to address these factors in order to reduce maternal mortality in the study area.

  9. Recognition Memory Span in Autopsy-Confirmed Dementia with Lewy Bodies and Alzheimer’s Disease

    PubMed Central

    Salmon, David P.; Heindel, William C.; Hamilton, Joanne M.; Filoteo, J. Vincent; Cidambi, Varun; Hansen, Lawrence A.; Masliah, Eliezer; Galasko, Douglas

    2016-01-01

    Evidence from patients with amnesia suggests that recognition memory span tasks engage both long-term memory (i.e., secondary memory) processes mediated by the diencephalic-medial temporal lobe memory system and working memory processes mediated by fronto-striatal systems. Thus, the recognition memory span task may be particularly effective for detecting memory deficits in disorders that disrupt both memory systems. The presence of unique pathology in fronto-striatal circuits in Dementia with Lewy Bodies (DLB) compared to AD suggests that performance on the recognition memory span task might be differentially affected in the two disorders even though they have quantitatively similar deficits in secondary memory. In the present study, patients with autopsy-confirmed DLB or AD, and normal control (NC) participants, were tested on separate recognition memory span tasks that required them to retain increasing amounts of verbal, spatial, or visual object (i.e., faces) information across trials. Results showed that recognition memory spans for verbal and spatial stimuli, but not face stimuli, were lower in patients with DLB than in those with AD, and more impaired relative to NC performance. This was despite similar deficits in the two patient groups on independent measures of secondary memory such as the total number of words recalled from Long-Term Storage on the Buschke Selective Reminding Test. The disproportionate vulnerability of recognition memory span task performance in DLB compared to AD may be due to greater fronto-striatal involvement in DLB and a corresponding decrement in cooperative interaction between working memory and secondary memory processes. Assessment of recognition memory span may contribute to the ability to distinguish between DLB and AD relatively early in the course of disease. PMID:26184443

  10. Metastatic breast cancer patients: attitudes toward tissue donation for rapid autopsy.

    PubMed

    Achkar, Tala; Wilson, John; Simon, Jacqueline; Rosenzweig, Margaret; Puhalla, Shannon

    2016-01-01

    Rapid autopsy (RA) offers a unique opportunity to obtain a large amount of metastatic tissue at death in order to deepen existing understanding of cancer evolution and heterogeneity. In breast cancer, understanding metastasis is particularly valuable given that treatment regimens are based on the traditional hormone and HER2 receptor status as well as evolving genomic data of the primary tumor. We aimed to elucidate the attitudes and interests of patients with metastatic breast cancer (MBC) toward RA, and to identify associated demographic or disease characteristics that may influence patient attitudes and interest. Ninety-seven patients with MBC were surveyed over the course of 12 months at a large, urban comprehensive cancer center's breast cancer outpatient clinic. 93/97 patients completed the survey sufficiently to be included in the analysis. Fisher's exact test was employed for categorical variables, and t test and rank-sum tests for continuous variables. p values ≤0.05 were considered statistically significant. Of the 93 patients with MBC analyzed, 87 % were willing to donate tissue at death. Marital status and younger age were associated with willingness to donate (p = 0.000, p = 0.025, respectively). Race, employment status, religion/spirituality, and cancer subtype were not associated with likelihood of donating. Forty-five percent of patients felt that doctors should ask about RA at diagnosis of early-stage breast cancer rather than during late-stage disease. These data provide evidence that an RA program would be welcomed by patients and requires initiative by providers. PMID:26705147

  11. Sudden infant deaths from undiagnosed ventricular septal defect - Report of two autopsy cases.

    PubMed

    Nishikata, Rie; Kato, Naho; Suto, Miwako; Rinnou, Mami; Mizusawa, Ikubumi; Kuroda, Naohito

    2016-09-01

    Ventricular septal defect (VSD) has a relatively non-aggressive clinical course; either spontaneous closure or causing congestive heart failure treatable with surgical intervention. We present two autopsy cases of sudden infant deaths from clinically undiagnosed VSDs. Case 1 was an 18-day-old boy. As the deceased coughed and became limp after feeding, he was carried to a hospital. Heart murmur was not auscultated there, so he was brought back to home. He presented severe dyspnea and then he was pronounced dead the next day. Case 2 was a 3-week-old boy. Any abnormality was pointed out at physical examination, although his mother felt his wheeze. He developed respiratory arrest at home in the morning and then he was confirmed dead at the hospital. Heart weights of these babies were heavier than mean weights of each normal development. There were perimembranous VSDs in both cases. Histology revealed that the pulmonary arterial walls were thickened. We diagnosed the cause of death in these cases was cardiac collapse with pulmonary hypertension due to VSD. Congenital heart diseases can be diagnosed as early as before birth, because echocardiograph and fetal echography are prevalent in these days. Most VSDs can be noticed by systolic murmur even today. We consider that the failure of initial clinical diagnosis of VSD in primary physical assessment could lead unexpected sudden death. These two cases reminded us to the importance of auscultation which is conventional but as one of the indispensable measure to find a clue for the congenital abnormality. PMID:27591530

  12. Molecular pathology of pulmonary edema after injury in forensic autopsy cases.

    PubMed

    Wang, Qi; Ishikawa, Takaki; Michiue, Tomomi; Zhu, Bao-Li; Guan, Da-Wei; Maeda, Hitoshi

    2012-11-01

    The lung is vulnerable to trauma; pulmonary edema starts quickly as part of the systemic responses involved in shock. The present study investigated the molecular pathology of posttraumatic alveolar damage and responses involving pulmonary edema in forensic autopsy cases of injury (n = 66) compared with acute cardiac death cases (n = 13). Intrapulmonary mRNA and immunohistochemical expressions of matrix metalloproteinases (MMPs; MMP-2 and MMP-9), intercellular adhesion molecule-1, claudin-5, and aquaporins (AQPs, AQP-1 and AQP-5) were examined. Subacute injury deaths showed an increase in lung weight similar to that in acute cardiac death, but relative mRNA quantification using the Taqman real-time PCR assay demonstrated different findings among the causes of death; higher expressions were detected for all markers, except for AQP-5 in sharp instrument injury, for MMP-2 in blunt brain injury, and for MMP-9 in non-brain blunt injury, but these expression levels were lower in acute cardiac death. In immunostaining, only MMPs showed differences among the causes of death: MMP-2 expression was evident in most subacute deaths due to blunt brain injury and sharp instrument injury, whereas MMP-9 was intensely positive in those of non-brain blunt injury and sharp instrument injury. These findings suggest significant differences in the mechanism of pulmonary edema among fatal injuries and acute cardiac death, especially between blunt and sharp instrument injury. Systematic analysis of gene expressions using real-time PCR in combination with immunohistochemistry may be useful in evaluating pulmonary damage and responses after injury in death investigations, especially in connection with posttraumatic shock. PMID:22885909

  13. Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy.

    PubMed

    Quan, L; Zhu, B-L; Ishikawa, T; Michiue, T; Zhao, D; Li, D-R; Ogawa, M; Maeda, H

    2008-11-01

    Circulating erythropoietin (EPO) is mainly produced in the kidneys, depending on blood oxygen level. The present study investigated the postmortem serum EPO levels with regard to the cause of death and survival time. Serial medicolegal autopsy cases of postmortem time within 48 h (n = 536) were examined. Serum EPO levels were within the clinical reference range in most cases. Uremic patients with medical administration of an EPO agent (n = 11) showed a markedly high level (140-4,850 mU/ml; median, 1,798 mU/ml). Otherwise, an elevation in serum EPO level (>30 mU/ml) was mainly seen in protracted deaths due to blunt injury and fire fatality, depending on the survival time (r = 0.69, p < 0.0001, and r = 0.45, p < 0.0001, respectively), and in subacute deaths from gastrointestinal bleeding and infectious diseases. However, mildly to moderately elevated serum EPO levels were sporadically found in acute deaths due to mechanical asphyxiation, fire fatality, and acute ischemic heart disease, and in fatal hypothermia cases, especially for elderly subjects. Protracted deaths due to mechanical asphyxiation and ischemic heart disease did not show any survival time-dependent increase in serum EPO level (p > 0.05). EPO was immunohistochemically detected in the tubular epithelia and interstitial cells, showing no evident difference among the causes of death, independent of survival time or serum level. These findings suggest that serum EPO can be used as a marker for investigating anemia and/or hypoxia as a consequence of fatal insult in subacute or prolonged deaths, or a predisposition to traumatic deaths or fatal heart attacks in acute deaths. PMID:18682967

  14. Comparison of physician-certified verbal autopsy with computer-coded verbal autopsy for cause of death assignment in hospitalized patients in low- and middle-income countries: systematic review

    PubMed Central

    2014-01-01

    Background Computer-coded verbal autopsy (CCVA) methods to assign causes of death (CODs) for medically unattended deaths have been proposed as an alternative to physician-certified verbal autopsy (PCVA). We conducted a systematic review of 19 published comparison studies (from 684 evaluated), most of which used hospital-based deaths as the reference standard. We assessed the performance of PCVA and five CCVA methods: Random Forest, Tariff, InterVA, King-Lu, and Simplified Symptom Pattern. Methods The reviewed studies assessed methods’ performance through various metrics: sensitivity, specificity, and chance-corrected concordance for coding individual deaths, and cause-specific mortality fraction (CSMF) error and CSMF accuracy at the population level. These results were summarized into means, medians, and ranges. Results The 19 studies ranged from 200 to 50,000 deaths per study (total over 116,000 deaths). Sensitivity of PCVA versus hospital-assigned COD varied widely by cause, but showed consistently high specificity. PCVA and CCVA methods had an overall chance-corrected concordance of about 50% or lower, across all ages and CODs. At the population level, the relative CSMF error between PCVA and hospital-based deaths indicated good performance for most CODs. Random Forest had the best CSMF accuracy performance, followed closely by PCVA and the other CCVA methods, but with lower values for InterVA-3. Conclusions There is no single best-performing coding method for verbal autopsies across various studies and metrics. There is little current justification for CCVA to replace PCVA, particularly as physician diagnosis remains the worldwide standard for clinical diagnosis on live patients. Further assessments and large accessible datasets on which to train and test combinations of methods are required, particularly for rural deaths without medical attention. PMID:24495312

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

    PubMed Central

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

    2011-01-01

    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. PMID:21876973

  16. Pseudo-Hirschsprung's disease with rectal hypoganglionosis: an autopsied case of circulatory failure due to severe constipation.

    PubMed

    Nishijima, Akio; Shiotani, Seiji; Hayakawa, Hideyuki; Nishijima, Haruo

    2015-05-01

    We report a 21-year-old female patient who suddenly died of circulatory failure due to pressure from megacolon allied with pseudo-Hirschsprung's disease. Since 3 years before her death, she had exhibited the feeling of abdominal distention, which was diagnosed as constipation. However, her constipation did not respond well to the prescribed oral administration of laxatives and enemas. She was found dead at home in the morning, lying on her back. An autopsy revealed a decreased number of ganglion cells in the rectum, suggesting hypoganglionosis. In cases of intractable chronic constipation, careful investigation of the cause of such symptoms is important. PMID:25497871

  17. The attempt on the life of Reinhard Heydrich, architect of the "final solution": a review of his treatment and autopsy.

    PubMed

    Weisz, George M; Albury, William R

    2014-04-01

    Reinhard Heydrich, architect of the "Final solution of the Jewish problem," had a meteoric career in the SS. He organized the Wannsee Conference and created the SS killing squads. Under his leadership as Acting Reich Protector of Bohemia and Moravia, the suppression of the Czech community was brutal. An attempt on his life in Prague was unsuccessful but it left him severely injured and he died eight days later. Reviewing the available information on his hospital treatment and the autopsy report, it is suggested that Heydrich received substandard medical treatment, quite likely a result of political interference from rival members of the SS hierarchy. PMID:24834756

  18. [Incidence of scalp involvement by Demodex folliculorum Simon ectoparasites in a pathologic-anatomic and forensic medicine autopsy sample].

    PubMed

    Hellerich, U; Metzelder, M

    1994-01-01

    29% of unselected pathological and forensic autopsy cases revealed mites of the species Demodex folliculorum longus and brevis in hair follicles and sebaceous glands of the scalp. The attack by these parasites was equal in male and female subjects and correlated to the number of sebaceous glands but not to the density of hair follicles. However there was a tendency to an increased number of parasites inhabiting the scalp of people of advanced age, dark hair colour or with a bald head. A chronic lymphocytic infiltration of the skin was conspicuous in more than 70% of cases with Demodicosis folliculorum. PMID:7811138

  19. Validating hierarchical verbal autopsy expert algorithms in a large data set with known causes of death

    PubMed Central

    Kalter, Henry D; Perin, Jamie; Black, Robert E

    2016-01-01

    Background Physician assessment historically has been the most common method of analyzing verbal autopsy (VA) data. Recently, the World Health Organization endorsed two automated methods, Tariff 2.0 and InterVA–4, which promise greater objectivity and lower cost. A disadvantage of the Tariff method is that it requires a training data set from a prior validation study, while InterVA relies on clinically specified conditional probabilities. We undertook to validate the hierarchical expert algorithm analysis of VA data, an automated, intuitive, deterministic method that does not require a training data set. Methods Using Population Health Metrics Research Consortium study hospital source data, we compared the primary causes of 1629 neonatal and 1456 1–59 month–old child deaths from VA expert algorithms arranged in a hierarchy to their reference standard causes. The expert algorithms were held constant, while five prior and one new “compromise” neonatal hierarchy, and three former child hierarchies were tested. For each comparison, the reference standard data were resampled 1000 times within the range of cause–specific mortality fractions (CSMF) for one of three approximated community scenarios in the 2013 WHO global causes of death, plus one random mortality cause proportions scenario. We utilized CSMF accuracy to assess overall population–level validity, and the absolute difference between VA and reference standard CSMFs to examine particular causes. Chance–corrected concordance (CCC) and Cohen’s kappa were used to evaluate individual–level cause assignment. Results Overall CSMF accuracy for the best–performing expert algorithm hierarchy was 0.80 (range 0.57–0.96) for neonatal deaths and 0.76 (0.50–0.97) for child deaths. Performance for particular causes of death varied, with fairly flat estimated CSMF over a range of reference values for several causes. Performance at the individual diagnosis level was also less favorable than that for

  20. Metastatic progression of breast cancer: insights from 50 years of autopsies.

    PubMed

    Cummings, Margaret C; Simpson, Peter T; Reid, Lynne E; Jayanthan, Janani; Skerman, Joanna; Song, Sarah; McCart Reed, Amy E; Kutasovic, Jamie R; Morey, Adrienne L; Marquart, Louise; O'Rourke, Peter; Lakhani, Sunil R

    2014-01-01

    There remain no clear guidelines for the optimal management of patients with metastatic breast cancer. To better understand its natural history, we undertook a detailed examination of 197 autopsies performed on women who died of breast cancer. We reviewed clinical, treatment and pathological aspects of all cases and, additionally, pathological features and biomarker expression (ER, PgR, HER2, EGFR, p53, Ki67, c-Kit, CK AE1/AE3) were assessed in detail for the primary tumour and matched metastases for 55 of the cases. Genomes of the primary tumour and multiple metastases were analysed by array-based comparative genomic hybridization for six cases(##) . 945 metastatic deposits were identified, with a median of four/patient. The most common organs involved were lung/pleura (80%), bone (74%), liver (71%) and non-axillary lymph nodes (55%). Major findings included: (a) patients with CNS metastases were more likely to have bone metastases (p < 0.013); (b) younger age was associated with metastasis to the liver (≤ 49 years; p < 0.001) and to gynaecological organs (≤ 49 years; p = 0.001); (c) surgical excision of the primary tumour was associated with metastasis to the liver (p = 0.002); and (d) ER and PgR showed down-regulation during progression in a non-random manner, particularly in lung/pleura (ER; p < 0.001), liver and bone metastases. Genomic analysis revealed DNA copy number variation between the primary tumour and metastases (e.g. amplification of 2q11.2-q12.1 and 10q22.2-q22.3) but little variation between metastases from the same patient. In summary, the association of CNS and bone metastases, liver and gynaecological metastases in young women and the risk of liver metastases following surgery have important implications for the management of patients with breast cancer. Clonal heterogeneity of the primary tumour is important in developing metastatic propensity and the change in tumour phenotype during progression/colonization highlights the importance

  1. Plutonium in Colorado residents: results of autopsy bone samples collected during 1975-1979.

    PubMed

    Ibrahim, S A; Warren, G M; Whicker, F W; Efurd, D W

    2002-08-01

    Concentrations of (239,240)Pu and the 240Pu/239Pu atom ratios were measured in rib samples from 55 non-occupationally exposed Colorado residents. Samples were collected at autopsy during 1975-1979 under an earlier study intended to compare plutonium levels in liver and lung of people who lived at various proximities to the Rocky Flats Environmental Technology Site (RFETS) near Denver. Overall, median (239,240)Pu concentrations from rib samples were 100, 80, and 57 microBq g(-1) ash weight for area locations A, B, and C, respectively. Area A encompassed subjects who lived within 25 km of RFETS, area B was between 25 and 50 km from RFETS, and area C included all of Colorado outside 50 km from the site and east of the continental divide. The corresponding median plutonium skeletal burdens estimated for these area locations were 146, 93, and 71 mBq, respectively. A statistically significant difference was noted only between plutonium concentrations in male rib samples and their skeletal burdens from area A compared to area C. However, based on a regression analysis of all study subjects, distance from RFETS was not statistically correlated to plutonium rib concentrations or skeletal burdens in this sample. Overall, median 240Pu/239Pu atom ratios were 0.20, 0.18, and 0.17 for areas A, B, and C, respectively. Although higher (239,240)Pu concentrations and skeletal burdens were indicated in area A males than area C males, we cannot conclude that RFETS releases may have caused this difference. The decreasing trends in the 240Pu/239Pu ratios with distance from RFETS are contrary with such a conclusion and strongly indicate that the material was primarily global fallout rather than weapons-grade plutonium that was processed at RFETS. Furthermore, there are other plausible explanations for the differences observed between area A and C residents. These include a decreasing trend in global fallout from the Rocky Mountain foothills eastward, smoking history differences, sample

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

    PubMed Central

    Aborigo, Raymond A.; Allotey, Pascale; Tindana, Paulina; Azongo, Daniel; Debpuur, Cornelius

    2013-01-01

    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

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

    PubMed Central

    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 post-mortem brain magnetic resonance imaging scans. Methenamine silver staining was used for amyloid-β and modified Bielschowsky method for neurofibrillary tangles and neuritic plaques. Macroscopic infarcts were identified from cerebral hemispheres, brainstem and cerebellum slices. Standardized methods were used to determine microscopic infarcts, cerebral amyoloid angiopathy, and α-synuclein pathology. Magnetic resonance imaging was used for visual ratings of the degree of medial temporal lobe atrophy, and periventricular and deep white matter hyperintensities. Elevated baseline homocysteine was associated with increased neurofibrillary tangles count at the time of death: for the highest homocysteine quartile, odds ratio (95% confidence interval) was 2.60 (1.28–5.28). The association was observed particularly in people with dementia, in the presence of cerebral infarcts, and with longer time between the baseline homocysteine assessment and death. Also, elevated homocysteine tended to relate to amyloid-β accumulation, but this was seen only with longer baseline-death interval: odds ratio (95% confidence interval) was 2.52 (0.88–7.19) for the highest homocysteine quartile. On post-mortem magnetic resonance imaging, for the highest homocysteine quartile odds ratio (95% confidence interval) was 3.78 (1.12–12.79) for more severe medial temporal atrophy and 4.69 (1.14–19.33) for more severe periventricular white matter hyperintensities. All associations were independent of

  4. [Latent malignant lymphoma diagnosed at autopsy in a patient with cold agglutinin disease coexisting thrombotic thrombocytopenic purpura].

    PubMed

    Shigeoka, Toru; Yamagata, Hiroki; Ishido, Aki; Tominaga, Takayuki; Kamei, Toshiaki; Takahashi, Toru

    2013-12-01

    An 89-year-old woman presented to our hospital with hemolytic anemia and a high titer of cold agglutinins. Red cell agglutination was observed on a blood smear. Agglutination visibly decreased after warming the blood; therefore, the patient was diagnosed with cold agglutinin disease (CAD). Bone marrow aspiration revealed no infiltration of malignant cells. Computed tomography indicated moderate splenomegaly. The patient had neither an infection nor autoimmune disease. Initial steroid therapy was ineffective and hemolysis worsened. Meanwhile, thrombocytopenia, delirium, fever, and schistocytes in the blood were observed. The progression of hemolysis was attributed not only to CAD but also to coexisting thrombotic thrombocytopenic purpura (TTP) because of the decreased ADAMTS 13 level. Autopsy revealed mild paraaortic lymphadenopathy and splenomegaly. Microscopic examination revealed lymphoma cell infiltration in the spleen, liver, bone marrow, and paraaortic lymph nodes. These observations suggested that TTP and CAD were both secondary complications. This case highlights the importance of an autopsy for the detection of latent lymphoma, which can be difficult to diagnose before the patient's death. Careful examination to exclude lymphomas is important in patients with CAD at the time of diagnosis. PMID:24452150

  5. Unique morphologic and clinical features of liver predominant/primary small cell carcinoma - autopsy and biopsy case series

    PubMed Central

    Lo, Amy A.; Lo, Edward C.; Li, Haonan; Zhang, Wanying; Liao, Jie; Rao, M. Sambasivia; Miller, Frank; Yang, Guang-Yu

    2014-01-01

    Liver predominant small cell carcinoma is rare, but often presents as hyper-acute liver failure with unknown primary and is a medical emergency. We present 2 autopsy and 7 biopsy cases of liver predominant small cell carcinoma and demonstrate that these patients present with liver failure and identifiable hepatomegaly, but lack discrete lesions on imaging, as well as no mass lesions identified in other organs including lung. Compared to the multiple nodules of metastatic small cell carcinoma in the liver, unique morphologic feature of liver predominant/primary small cell carcinoma in autopsy and biopsy specimens was a diffuse infiltration of small, blue, neoplastic cells predominantly in the sinusoidal space in the liver parenchyma. Prior to diagnosing liver predominant/primary small cell carcinoma, other infiltrating small blue cell neoplasms including lymphoma and peripheral neuroectodermal tumor need to be ruled out through immunohistochemistry (IHC). We therefore demonstrate that liver biopsy together with a rapid panel of immunostains is necessary to firmly establish a diagnosis of liver predominant small cell carcinoma and allow clinicians to immediately implement potentially lifesaving chemotherapy. PMID:24667053

  6. Unique morphologic and clinical features of liver predominant/primary small cell carcinoma--autopsy and biopsy case series.

    PubMed

    Lo, Amy A; Lo, Edward C; Li, Haonan; Zhang, Wanying; Liao, Jie; Rao, M Sambasivia; Miller, Frank; Yang, Guang-Yu

    2014-06-01

    Liver predominant small cell carcinoma is rare but often presents as hyperacute liver failure with unknown primary and is a medical emergency. We present 2 autopsy and 7 biopsy cases of liver predominant small cell carcinoma and demonstrate that these patients present with liver failure and identifiable hepatomegaly but lack discrete lesions on imaging as well as no mass lesions identified in other organs including lung. Compared with the multiple nodules of metastatic small cell carcinoma in the liver, unique morphologic feature of liver predominant/primary small cell carcinoma in autopsy and biopsy specimens was a diffuse infiltration of small blue neoplastic cells predominantly in the sinusoidal space in the liver parenchyma. Before diagnosing liver predominant/primary small cell carcinoma, other infiltrating small blue cell neoplasms including lymphoma and peripheral neuroectodermal tumor need to be ruled out through immunohistochemistry. We, therefore, demonstrate that liver biopsy together with a rapid panel of immunostains is necessary to firmly establish a diagnosis of liver predominant small cell carcinoma and allow clinicians to immediately implement potentially lifesaving chemotherapy. PMID:24667053

  7. The correlation of epicardial adipose tissue on postmortem CT with coronary artery stenosis as determined by autopsy.

    PubMed

    Sequeira, Damien I; Ebert, Lars C; Flach, Patricia M; Ruder, Thomas D; Thali, Michael J; Ampanozi, Garyfalia

    2015-06-01

    The goal of this study was to assess whether epicardial and paracardial adipose tissue volumes, as determined by computed tomography (CT), correlate with coronary artery stenosis as determined by autopsy. The postmortem CT data and autopsy findings of 116 adult human decedents were retrospectively compared. Subjects were classified into three groups according to their degree of coronary artery stenosis: ≥50, <50%, and no stenosis. Epicardial and paracardial adipose tissue volumes were calculated based on manual segmentation after threshold based masking. In addition, epicardial adipose tissue thickness was measured using a caliper. All three parameters (thickness of epicardial fat and volumes of both epicardial and paracardial fat) were compared among the three groups and correlated with the degree of coronary artery stenosis. The group with no coronary artery stenosis showed the lowest mean values of epicardial adipose tissue volume, while the coronary artery stenosis ≥50 % group showed the highest volume. All measured variables (thickness of epicardial fat and volumes of both epicardial and paracardial fat) correlated significantly with the grade of coronary artery stenosis, even after controlling for BMI, however, epicardial adipose tissue volume exhibited the strongest correlation. This study reveals that there is an association between the degree of coronary artery stenosis and the amount of epicardial fat tissue: The larger the volume of epicardial fat, the higher the degree of coronary artery stenosis. PMID:25711291

  8. Metastatic hepatocellular carcinoma of the maxillary sinus: a rare autopsy case without lung metastasis and a review.

    PubMed

    Okada, H; Kamino, Y; Shimo, M; Kitamura, E; Katoh, T; Nishimura, H; Akimoto, Y; Kaneda, T; Hinata, M; Yamamoto, H

    2003-02-01

    A rare case of metastatic hepatocellular carcinoma (HCC) of the maxillary sinus in a 67-year-old man is reported along with the findings at autopsy. A fine needle aspiration biopsy specimen revealed a characteristic tumour structure resembling primary HCC. At autopsy, metastatic lesions were recognized in the bilateral adrenals, spleen, sternum, vertebrae and lymph node at the lesser curvature of the stomach, but not in the lung, suggesting that the HCC had metastasized to the maxillary sinus via the plexus venous vertebralis and/or the azygos vein, or lymph duct. In our reviewed 29 cases of metastatic HCC in the oro-maxillofacial region, most patients were men in the 50- to 70-year age range. At least 11 cases did not have lung metastasis, and in 18, metastasis to the oro-maxillofacial region was the first sign of HCC. One should be aware of the possibility to encounter the oral lesion as first sign of metastatic HCC. PMID:12653243

  9. Presence of Citrullinated Histone H3-Positive Neutrophils in Microscopic Polyangiitis from the Early Phase: An Autopsy Proven Case.

    PubMed

    Matsuda, Yoko; Hamayasu, Hideki; Seki, Atsuko; Nonaka, Keisuke; Wang, Tan; Matsumoto, Takumi; Hamano, Yoshitomo; Sumikura, Hiroyuki; Kumasaka, Toshio; Murayama, Shigeo; Ishizu, Akihiko; Shimizu, Akira; Sugihara, Takahiko; Arai, Tomio

    2016-08-01

    A 76-year-old man was admitted with general fatigue, weight loss, fever, headache, renal failure, and a high serum level of myeloperoxidase-antineutrophil cytoplasmic antibody. Biopsy revealed citrullinated histone H3 (citH3)-positive neutrophils adherent to the temporal artery endothelium. Three days after completing pulse steroid therapy, he suffered from a sudden disturbance of consciousness and died. On autopsy, the kidneys showed the most severe vasculitis with dense infiltration of citH3-positive neutrophils. The lungs showed intra-alveolar hemorrhage due to capillaritis. Severe brain hemorrhage was found in the left frontal lobe and putamen with uncal herniation. No vasculitis or thrombi was observed in the brain. The right dura mater was thickened due to fibrosis and inflammation. In conclusion, autopsy revealed systemic vasculitis with infiltration of abundant citH3-positive neutrophils, suggesting that the neutrophil extracellular trap formation and citH3 might play important roles in the early phases and development of microscopic polyangiitis. PMID:27427341

  10. Spectrum of pediatric developmental and genetic renal lesions and associated congenital malformations--an autopsy study from north India.

    PubMed

    Kakkar, Nandita; Menon, Santosh; Radotra, B D

    2006-01-01

    Pediatric developmental and genetic renal lesions are a known cause of mortality in the perinatal/neonatal period. These lesions are associated with a wide range of extrarenal congenital malformations that influence the outcome of the patients. In this autopsy study, we have analyzed the spectrum of pediatric developmental and genetic renal lesions and their associated congenital malformations. A total of 4,099 autopsies (20 weeks of gestation to 1 year of life) were reviewed, of which 158 cases (3.85%) of pediatric developmental (143 cases) and genetic renal lesions (15 cases) were found. Autosomal recessive polycystic kidney disease was the commonest genetic lesion. Primitive ducts with cuffing of immature mesenchyme--the sine qua non of renal dysplasia--was found in all cases of dysplasia. Associated congenital malformations were seen in all cases and thus a thorough search for them is mandatory. Ductal plate malformation was found in all cases of autosomal recessive polycystic kidney disease and in 1 case of bilateral multicystic dysplasia. PMID:16754487

  11. The problem with medical research on tissue and organ samples taken in connection with forensic autopsies in France.

    PubMed

    Rougé-Maillart, C; Dupont, V; Jousset, N

    2016-02-01

    Currently, in France, it is legally impossible to conduct scientific research on tissue and organ samples taken from forensic autopsies. In fact, the law schedules the destruction of such samples at the end of the judicial investigation, and the common law rules governing cadaver research cannot be applied to the forensic context. However, nothing seems in itself to stand in the way of such research since, despite their specific nature, these samples from forensic autopsies could be subject, following legislative amendments, to common law relating to medical research on samples taken from deceased persons. But an essential legislative amendment, firstly to allow the Biomedicine Agency to become authorized to issue a research permit and secondly, to change the research conditions in terms of the non-opposition of the deceased to said research. Such an amendment would be a true breakthrough because it would allow teams to continue to move forward calmly in research, and allow this research to be placed within a legal framework, which would promote international exchanges. PMID:26694871

  12. The use of simplified verbal autopsy in identifying causes of adult death in a predominantly rural population in Ethiopia

    PubMed Central

    Lulu, Kidest; Berhane, Yemane

    2005-01-01

    Background Information on adult mortality is essentially non-existent in Ethiopia particularly from rural areas where access to health services is limited and most deaths occur at home. This study was conducted with the aim of identifying causes of adult death in a rural population of Ethiopia using a simplified verbal autopsy instrument. Methods All deaths in the age-group 15–49 years during the period of 1995–99 were taken from computerized demographic surveillance database maintained by the Butajira Rural Health Program. Data on the causes of death were collected from close relatives of the deceased persons by lay interviewers. Causes of death were diagnosed using "expert algorithm" programmed onto a computer. Results The major causes of death were acute febrile illnesses (25.2%), liver diseases (11.3%), diarrheal diseases (11.1%), tuberculosis (9.7%) and HIV/AIDS (7.4%). Overall communicable diseases accounted for 60.8% of the deaths. The high levels of mortality from communicable diseases reflect the poor socioeconomic development of the country, and the general poor coverage of health and education services in rural Ethiopia. The tools used in this study can easily be added-on to the numerous health surveys conducted in the country. Conclusion The simplified approach to verbal autopsy diagnosis can produce useful data that can effectively guide priority health interventions in rural areas where routine information system is either very weak or non-existent. PMID:15935096

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

    PubMed

    Nielsen, Pia Rude; Gheorghe, Alexandra; Lynnerup, Niels

    2014-09-01

    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. PMID:25002407

  14. Midbrain-to-pons ratio in autopsy-confirmed progressive supranuclear palsy: replication in an independent cohort.

    PubMed

    Kaasinen, Valtteri; Kangassalo, Noora; Gardberg, Maria; Isotalo, Juuso; Karhu, Jari; Parkkola, Riitta; Sonninen, Pirkko

    2015-07-01

    Recent neuropathologically confirmed clinical data suggest that the midbrain-to-pons ratio, as calculated from conventional brain MRI, has high specificity and sensitivity for the diagnosis of progressive supranuclear palsy (PSP). Here, we aimed to replicate these findings in an independent autopsy-confirmed cohort of 6 PSP patients and 23 non-PSP patients. Patients with confirmed PSP had clearly lower midbrain-to-pons ratios compared to non-PSP patients (p < 0.0001). All non-PSP patients had midbrain-to-pons ratios higher than 0.50, whereas all but one PSP patient had a ratio lower than 0.50. The positive predictive value (PPV) of the ratio (<0.50) was 100% and the negative predictive value (NPV) was 95.8 %. The results of this second autopsy-confirmed sample confirm that midbrain-to-brain ratios constitute reliable and clinically useful estimates of diagnostic midbrain atrophy in relation to PSP pathology. PMID:25805708

  15. Postmortem computed tomography and magnetic resonance imaging facilitates forensic autopsy in a fatal case of poisoning with formic acid, diphenhydramine, and ethanol.

    PubMed

    Berger, Florian; Steuer, Andrea E; Rentsch, Katharina; Gascho, Dominic; Stamou, Stamatios; Schärli, Sarah; Thali, Michael J; Krämer, Thomas; Flach, Patricia M

    2016-09-01

    A case of fatal poisoning by ingesting formic acid, diphenhydramine, and ethanol by a 25-year-old woman who committed suicide is presented. Prior to autopsy, postmortem computed tomography and postmortem magnetic resonance tomography were performed and revealed severe damage to the stomach, the left thoracic wall, and parts of the liver. Imaging detected acid-induced fluid-fluid level within the thoracic cavity (fat-equivalent fluid and necrotic pleural effusion). This case report illustrates that postmortem cross-sectional imaging may facilitate dissection of severely damaged or complex regions, and may provide additional information compared to autopsy and toxicological examinations alone. PMID:27427196

  16. Small airway remodeling in acute respiratory distress syndrome: a study in autopsy lung tissue

    PubMed Central

    2011-01-01

    Introduction Airway dysfunction in patients with the Acute Respiratory Distress Syndrome (ARDS) is evidenced by expiratory flow limitation and dynamic hyperinflation. These functional alterations have been attributed to closure/obstruction of small airways. Airway morphological changes have been reported in experimental models of acute lung injury, characterized by epithelial necrosis and denudation in distal airways. To date, however, no study has focused on the morphological airway changes in lungs from human subjects with ARDS. The aim of this study is to evaluate structural and inflammatory changes in distal airways in ARDS patients. Methods We retrospectively studied autopsy lung tissue from subjects who died with ARDS and from control subjects who died of non pulmonary causes. Using image analysis, we quantified the extension of epithelial changes (normal, abnormal and denudated epithelium expressed as percentages of the total epithelium length), bronchiolar inflammation, airway wall thickness, and extracellular matrix (ECM) protein content in distal airways. The Student's t-test or the Mann-Whitney test was used to compare data between the ARDS and control groups. Bonferroni adjustments were used for multiple tests. The association between morphological and clinical data was analyzed by Pearson rank test. Results Thirty-one ARDS patients (A: PaO2/FiO2 ≤200, 45 ± 14 years, 16 males) and 11 controls (C: 52 ± 16 years, 7 males) were included in the study. ARDS airways showed a shorter extension of normal epithelium (A:32.9 ± 27.2%, C:76.7 ± 32.7%, P < 0.001), a larger extension of epithelium denudation (A:52.6 ± 35.2%, C:21.8 ± 32.1%, P < 0.01), increased airway inflammation (A:1(3), C:0(1), P = 0.03), higher airway wall thickness (A:138.7 ± 54.3 μm, C:86.4 ± 33.3 μm, P < 0.01), and higher airway content of collagen I, fibronectin, versican and matrix metalloproteinase-9 (MMP-9) compared to controls (P ≤0.03). The extension of normal epithelium

  17. Study to increase the frequency of autopsies performed for cases of infant deaths--proposed revision of the law on postmortem examination and corpse preservation and other related regulations.

    PubMed

    Sawaguchi, A; Sawaguchi, T; Matoba, R; Togari, H; Nakagawa, S; Miyauchi, J; Nishida, H

    2002-09-14

    By definition, sudden infant death syndrome (SIDS) requires diagnosis through exclusion by conducting an autopsy. To obtain a reliable diagnosis of this disease, an autopsy is essential. However, the frequency with which autopsies are conducted in Japan is not sufficient to meet the need associated with the diagnosis of SIDS. To improve this frequency, various public policies, such as nationwide implementation of the administrative autopsy system (medical examiner system), the application of the practice of autopsy approved by families, and legally required autopsies, are being considered; but none has been put into practice. On the other hand, attention has been called to the fact that the Law on postmortem examination and corpse preservation, which was instituted at the end of the Second World War, requires updating. In the current report, it is proposed that the following be added to Article 8, item 3 of this Law: "the Metropolitan or Prefectural Governor must insist that an autopsy be conducted on all cases of a sudden and unexpected death of an infant to investigate the cause of this death." At present, the annual incidence of SIDS in Japan is reported to be 500. To put the above-recommended legal requirement into practice, the estimated annual addition to the budget, if conducted as approved or an administrative autopsy, will be in the order of 150,000-500,000 dollar, which is within the prescribed limits for an appropriation. PMID:12350310

  18. Comparison of intratumoral heterogeneity of HER2 expression between primary tumor and multiple organ metastases in gastric cancer: Clinicopathological study of three autopsy cases and one resected case.

    PubMed

    Saito, Takuya; Kondo, Chihiro; Shitara, Kohei; Ito, Yuichi; Saito, Noriko; Ikehara, Yuzuru; Yatabe, Yasushi; Yamamichi, Keigo; Tanaka, Hideo; Nakanishi, Hayao

    2015-06-01

    Intratumoral heterogeneity of HER2 expression in the metastatic foci of HER2-positive advanced gastric cancer remains unclear. In this study, we compared HER2 expression between primary and metastatic tumors in HER2-positive three autopsied cases and one resected case with multiple organ metastases by immunohistochemistry (IHC) and dual color in situ hybridization (DISH). All four cases judged positive (IHC3+) at the primary tumor tissues showed varying HER2 gene amplification (GA) status. One homogeneously HER2-positive autopsied case (Case 1) and one intratumorally heterogeneous positive resected case (Case 2) with high GA showed a homogeneous positive staining pattern in all the metastatic foci. One heterogeneously HER2-positive autopsied case (Case 3) with low GA showed a partially heterogeneous HER2 staining pattern in all the metastatic foci. In contrast, one heterogeneously HER2-positive autopsied case (Case 4) with equivocal GA showed a completely heterogeneous HER2 staining pattern in the metastatic foci. These results indicate that HER2-positive gastric cancers with low to high GA at the primary tumor show substantially homogeneous HER2 overexpression in the metastatic foci, whereas HER2-positive gastric cancers with equivocal GA expressed HER2 heterogeneously within the metastatic tumor, suggesting that metastatic foci of the latter HER2-positive cases would be potentially resistant to trastuzumab. PMID:25828363

  19. Developments of geriatric autopsy database and Internet-based database of Japanese single nucleotide polymorphisms for geriatric research (JG-SNP).

    PubMed

    Sawabe, Motoji; Arai, Tomio; Kasahara, Ichiro; Esaki, Yukiyoshi; Nakahara, Ken-ichi; Hosoi, Takayuki; Orimo, Hajime; Takubo, Kaiyo; Murayama, Shigeo; Tanaka, Noriko

    2004-08-01

    To facilitate geriatric research on the roles of genetic polymorphisms of candidate genes, two databases were developed based on data obtained from autopsy examinations of elderly subjects: the geriatric autopsy database (GEAD) and the Japanese single nucleotide polymorphisms (SNP) database for geriatric research (JG-SNP) which is accessible on the Internet (http://www.tmgh.metro.tokyo.jp/jg-snp/english/E_top.html). The data for the GEAD were derived from 1074 consecutive autopsy cases (565 male and 509 female cases) with an average age of 80 years. The GEAD was installed on a stand-alone Windows 2000 server using Oracle 8i as the database application. The GEAD contains clinical diagnoses of 26 geriatric diseases, histories of smoking and alcohol consumption, pathological findings (720 items), severity of atherosclerosis, genetic polymorphism data, etc. On the JG-SNP website, case distribution corresponding to a specified SNP or disease can be searched or downloaded. Although there are several Internet-based SNP databases such as dbSNP, no databases are available at present on the web that contain both SNP data and phenotypic data. As autopsy studies can provide large amounts of accurate medical information, including the presence of undiagnosed diseases such as latent cancers, the GEAD is a unique and excellent database for research on genetic polymorphisms. PMID:15336912

  20. [An autopsy case of progressive generalized muscle atrophy over 14 years due to post-polio syndrome].

    PubMed

    Oki, Ryosuke; Uchino, Akiko; Izumi, Yuishin; Ogawa, Hirohisa; Murayama, Shigeo; Kaji, Ryuji

    2016-01-01

    We report the case of a 72-year-old man who had contracted acute paralytic poliomyelitis in his childhood. Thereafter, he had suffered from paresis involving the left lower limb, with no relapse or progression of the disease. He began noticing slowly progressive muscle weakness and atrophy in the upper and lower extremities in his 60s. At the age of 72, muscle weakness developed rapidly, and he demonstrated dyspnea on exertion and dysphagia. He died after about 14 years from the onset of muscle weakness symptoms. Autopsy findings demonstrated motoneuron loss and glial scars not only in the plaque-like lesions in the anterior horns, which were sequelae of old poliomyelitis, but also throughout the spine. No Bunina bodies, TDP-43, and ubiquitin inclusions were found. Post-polio syndrome is rarely fatal due to rapid progressive dyspnea and dysphagia. Thus, the pathological findings in the patient are considered to be related to the development of muscle weakness. PMID:26616485

  1. Biomechanical and histologic investigation of cemented total hip arthroplasties. A study of autopsy-retrieved femurs after in vivo cycling.

    PubMed

    Maloney, W J; Jasty, M; Burke, D W; O'Connor, D O; Zalenski, E B; Bragdon, C; Harris, W H

    1989-12-01

    Eleven whole anatomic specimens of the femur were retrieved at autopsy from patients who previously had cemented total hip arthroplasty. Implant duration ranged from 0.5 to 210 months. Clinically and roentgenographically the implants were stable. A detailed biomechanical analysis evaluated bone strains and implant stability in both the single-limb stance and stair-climbing positions using a 100-pound spinal load. The stability offered by cement in these well-fixed prostheses was remarkable, with the maximum axial micromotion being 40 mu. This is a reflection of intimate osseointegration at the bone-cement interface with only rare intervening fibrous tissue. The strain gauge and photoelastic strain-coating studies revealed that marked stress shielding in the proximal medial femoral cortex persists long after a cemented femoral component is inserted. Even 17 years after surgery, the strain in the calcar region did not normalize. PMID:2582664

  2. Autopsy radiography: digital radiographs (DR) vs multidetector computed tomography (MDCT) in high-velocity gunshot-wound victims.

    PubMed

    Harcke, H Theodore; Levy, Angela D; Abbott, Robert M; Mallak, Craig T; Getz, John M; Champion, Howard R; Pearse, Lisa

    2007-03-01

    This study compared full-body digital radiography (DR) with multidetector computed tomography (MDCT) in the postmortem evaluation of gunshot wound (GSW) victims. Thirteen consecutive male GSW victims (mean age, 27 years) had full-body DR and MDCT prior to routine autopsy. DR successfully identified all metallic fragments, but MDCT was superior in its ability to precisely determine location because it provided 3-dimensional anatomic localization. In all cases, MDCT more accurately assessed organ injuries and wound tracks. Both DR and MDCT are limited in classifying multiple wounds and major vessel injury, but MDCT is generally superior to DR. MDCT shows significant advantages over DR in the forensic evaluation of GSW victims. This is particularly advantageous for the pathologist retrieving metallic fragments and for describing fracture detail accurately. Use of MDCT instead of radiographs will require medical examiners to become familiar with reading cross-sectional images. PMID:17325457

  3. Identification of arrhythmogenic right ventricular cardiomyopathy-causing gene mutations in young sudden unexpected death autopsy cases.

    PubMed

    Sato, Takako; Nishio, Hajime; Suzuki, Koichi

    2015-03-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) results in an increased risk of sudden death. We sought mutations of desmoglein-2 (DSG2), desmoplakin (DSP), and plakophilin-2 (PKP2) in 15 cases of sudden death whose causes of death could not be determined at autopsy. In three victims, mutations were identified in DSP. Two of these mutations were novel; one had previously been reported in a patient with ARVC that had been diagnosed clinically. Histological findings were not typical of ARVC; however, it was notable that these mutations were present in three of 15 cases, a relatively high proportion. The causal relationship between the mutations and ARVC is unclear, but the mutations might have been associated with faulty desmosomal proteins resulting in fatal arrhythmia. Combining information gathered by the traditional means of gross and histological examination with postmortem genetic analysis of young victims would assist in identifying their cause of death. PMID:25693453

  4. A double-suicide autopsy case of potassium poisoning by intravenous administration of potassium aspartate after intake of some psychopharmaceuticals.

    PubMed

    Watanabe, K; Hasegawa, K; Suzuki, O

    2011-07-01

    We report a curious double-suicide autopsy case of both male and female who died of potassium poisoning by intravenous administration of concentrated potassium aspartate solution. The plasma concentrations of potassium of the male and female subjects were as high as 49.7 and 62.8 mEq/L, respectively. In addition to the high concentrations of potassium, toxic levels of phenobarbital, promethazine and chlorpromazine, and relatively low levels of etizolam and brotizolam were also detected from whole blood and urine specimens of both cadavers. Twenty empty plastic bottles (10-mL capacity) labeled 'ASPARA® Potassium Injection 10 mEq' were found at the suicide spot. To our knowledge, this is the first description for suicidal death by potassium aspartate; in all of the previous literature, they used potassium chloride intravenously or per os. PMID:20670988

  5. Clinical and Pathological Findings on Intoxication by Yellow Phosphorus After Ingesting Firework Cracker: A Rare Case of Autopsy.

    PubMed

    Türkmen Şamdanci, Emine; Çakir, Ebru; Şahin, Nurhan; Elmali, Candan; Sayin, Sadegül

    2016-01-01

    Yellow phosphorus is a toxic substance used in the production of firework cracker, fireworks, ammunition and agricultural dung. When ingested, it shows its effects mainly in the liver, the kidneys, and the brain. A four-year-old girl had died as a result of acute hepatic failure caused by ingesting a firework cracker. The case showed high levels of hepatic enzymes, along with non-specific signs such as nausea, vomiting and diarrhea. Autopsy revealed diffuse microvesicular steatosis in the liver and disseminated degeneration in the proximal tubules of the kidneys. In cases with concomitant hepatorenal failure and cardiovascular collapse, death is inevitable. However, when only hepatic failure develops, hepatic transplantation may be lifesaving. Although intoxication from ingesting yellow phosphorus has a very high rate of mortality, forensic cases are extremely rare in the literature. PMID:24272931

  6. An escape from agony: A qualitative psychological autopsy study of women's suicide in a post-conflict Northern Uganda

    PubMed Central

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

    2012-01-01

    We set out to investigate suicide among women in a post-conflict context in Northern Uganda using qualitative psychological autopsy interviews. Three to five relatives and friends for each of the three suicides recruited were interviewed (N=11). Through interpretative phenomenological analysis (IPA) we found that the women all had been through traumatic experiences attributable to the protracted war/conflict between the rebel groups and Ugandan Government armed forces. Nevertheless, the decision of self-inflicted death seemed to have been due to a combination of unpleasant experiences/events that prevailed within the last 3 months prior to the suicide. These experiences are summarized in two broad themes: No control in life and No care. Changes in the traditional gender roles, men's quest for their lost masculinity, and women's attempt to fight for their rights that was perceived as a cultural transgression contributed to the women's suicides. PMID:22989691

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

    PubMed

    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%), <20 years of age (54%) and during their first-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

  8. An autopsy case of Hermansky-Pudlak syndrome: a case report and review of the literature on treatment.

    PubMed

    Harada, Tatsuhiko; Ishimatsu, Yuji; Nakashima, Shota; Miura, Shiro; Tomonaga, Masaomi; Kakugawa, Tomoyuki; Hara, Shintaro; Sakamoto, Noriho; Yoshii, Chiharu; Mukae, Hiroshi; Kawabata, Yoshinori; Kohno, Shigeru

    2014-01-01

    Hermansky-Pudlak syndrome (HPS) is a rare genetic disorder, the most common complication of which influencing the prognosis is pulmonary fibrosis. In the present report, we describe an autopsy case of a Japanese woman with HPS. The patient was diagnosed at 50 years of age based on the presence of oculocutaneous albinism, hemorrhagic diathesis, ceroid-lipofuscin accumulation and pulmonary fibrosis. Although systemic steroids, immunosuppressants and pirfenidone were administered for pulmonary involvement, she died from respiratory failure two years later. Obtaining an early diagnosis and taking into consideration the need for lung transplantation is necessary in order to improve the prognosis of HPS. We herein report this very rare Japanese case of HPS with a review of the treatment approaches for HPS complicated with pulmonary fibrosis. PMID:25447654

  9. An independent evaluation of plutonium body burdens in populations near Los Alamos Laboratory using human autopsy data.

    PubMed

    Gaffney, Shannon H; Donovan, Ellen P; Shonka, Joseph J; Le, Matthew H; Widner, Thomas E

    2013-06-01

    In the mid-1940s, the United States began producing atomic weapon components at the Los Alamos National Laboratory (LANL). In an attempt to better understand historical exposure to nearby residents, this study evaluates plutonium activity in human tissue relative to residential location and length of time at residence. Data on plutonium activity in the lung, vertebrae, and liver of nearby residents were obtained during autopsies as a part of the Los Alamos Tissue Program. Participant residential histories and the distance from each residence to the primary plutonium processing buildings at LANL were evaluated in the analysis. Summary statistics, including Student t-tests and simple regressions, were calculated. Because the biological half-life of plutonium can vary significantly by organ, data were analyzed separately by tissue type (lung, liver, vertebrae). The ratios of plutonium activity (vertebrae:liver; liver:lung) were also analyzed in order to evaluate the importance of timing of exposure. Tissue data were available for 236 participants who lived in a total of 809 locations, of which 677 were verified postal addresses. Residents of Los Alamos were found to have higher plutonium activities in the lung than non-residents. Further, those who moved to Los Alamos before 1955 had higher lung activities than those who moved there later. These trends were not observed with the liver, vertebrae, or vertebrae:liver and liver:lung ratio data, however, and should be interpreted with caution. Although there are many limitations to this study, including the amount of available data and the analytical methods used to analyze the tissue, the overall results indicate that residence (defined as the year that the individual moved to Los Alamos) may have had a strong correlation to plutonium activity in human tissue. This study is the first to present the results of Los Alamos Autopsy Program in relation to residential status and location in Los Alamos. PMID:23078914

  10. Quantification of immunohistochemical findings of neurofibrillary tangles and senile plaques for a diagnosis of dementia in forensic autopsy cases.

    PubMed

    Takayama, Mio; Kashiwagi, Masayuki; Matsusue, Aya; Waters, Brian; Hara, Kenji; Ikematsu, Natsuki; Kubo, Shin-Ichi

    2016-09-01

    We report the quantification of immunohistochemical findings for a diagnosis of dementia in autopsy cases among older decedents. Autopsy cases were selected with the following requirements: >65yo; no head injuries, thermal injuries, or heat stroke; no intracranial lesions; and within 48h of death. Among cases that met all requirements, 10 had a clinical diagnosis of dementia were included in dementia group. Non-dementia group consisted of 38 cases without any record of dementia. To compare these groups, immunohistochemically, beta-amyloid, tau protein, gephyrin, and IL-33 were examined in five regions. Quantitative analysis was performed by collecting with image data analyzed using analysis software. Image data on tau-immunopositive neurofibrillary tangles (NFT) and beta-amyloid-positive senile plaques (SP) were photographed. Criteria for dementia were made by counting and measuring NFT and SP from image data using software. Differences in SP and NFT were effective for discriminating between the two groups. These criteria may reveal the presence and progression of dementia. Total of tau-positive NFT in Ammon's horn (AH) may be useful for diagnosing dementia. When the total is more than 41 in approximately 6mm(2) of AH, the possibility of dementia is considered. Total of beta-amyloid-positive SP in the parahippocampal gyrus (PHG) may be useful for diagnosing dementia. When the total in approximately 5mm(2) of PHG is more than 47, the possibility of dementia is considered. Immunohistochemical staining may be more useful for obtaining image data for quantification than conventional staining techniques, such as Bielschowsky-Hirano's silver staining. PMID:27591545

  11. Strategies for searching medical natural language text. Distribution of words in the anatomic diagnoses of 7000 autopsy subjects.

    PubMed

    Moore, G W; Hutchins, G M; Miller, R E

    1984-04-01

    Computerized indexing and retrieval of medical records is increasingly important; but the use of natural language versus coded languages (SNOP, SNOMED) for this purpose remains controversial. In an effort to develop search strategies for natural language text, the authors examined the anatomic diagnosis reports by computer for 7000 consecutive autopsy subjects spanning a 13-year period at The Johns Hopkins Hospital. There were 923,657 words, 11,642 of them distinct. The authors observed an average of 1052 keystrokes, 28 lines, and 131 words per autopsy report, with an average 4.6 words per line and 7.0 letters per word. The entire text file represented 921 hours of secretarial effort. Words ranged in frequency from 33,959 occurrences of "and" to one occurrence for each of 3398 different words. Searches for rare diseases with unique names or for representative examples of common diseases were most readily performed with the use of computer-printed key word in context (KWIC) books. For uncommon diseases designated by commonly used terms (such as "cystic fibrosis"), needs were best served by a computerized search for logical combinations of key words. In an unbalanced word distribution, each conjunction (logical and) search should be performed in ascending order of word frequency; but each alternation (logical inclusive or) search should be performed in descending order of word frequency. Natural language text searches will assume a larger role in medical records analysis as the labor-intensive procedure of translation into a coded language becomes more costly, compared with the computer-intensive procedure of text searching. PMID:6546837

  12. Strategies for searching medical natural language text. Distribution of words in the anatomic diagnoses of 7000 autopsy subjects.

    PubMed Central

    Moore, G. W.; Hutchins, G. M.; Miller, R. E.

    1984-01-01

    Computerized indexing and retrieval of medical records is increasingly important; but the use of natural language versus coded languages (SNOP, SNOMED) for this purpose remains controversial. In an effort to develop search strategies for natural language text, the authors examined the anatomic diagnosis reports by computer for 7000 consecutive autopsy subjects spanning a 13-year period at The Johns Hopkins Hospital. There were 923,657 words, 11,642 of them distinct. The authors observed an average of 1052 keystrokes, 28 lines, and 131 words per autopsy report, with an average 4.6 words per line and 7.0 letters per word. The entire text file represented 921 hours of secretarial effort. Words ranged in frequency from 33,959 occurrences of "and" to one occurrence for each of 3398 different words. Searches for rare diseases with unique names or for representative examples of common diseases were most readily performed with the use of computer-printed key word in context (KWIC) books. For uncommon diseases designated by commonly used terms (such as "cystic fibrosis"), needs were best served by a computerized search for logical combinations of key words. In an unbalanced word distribution, each conjunction (logical and) search should be performed in ascending order of word frequency; but each alternation (logical inclusive or) search should be performed in descending order of word frequency. Natural language text searches will assume a larger role in medical records analysis as the labor-intensive procedure of translation into a coded language becomes more costly, compared with the computer-intensive procedure of text searching. PMID:6546837

  13. A dynamic magnetic shift method to increase nanoparticle concentration in cancer metastases: a feasibility study using simulations on autopsy specimens

    PubMed Central

    Nacev, Alek; Kim, Skye H; Rodriguez-Canales, Jaime; Tangrea, Michael A; Shapiro, Benjamin; Emmert-Buck, Michael R

    2011-01-01

    A nanoparticle delivery system termed dynamic magnetic shift (DMS) has the potential to more effectively treat metastatic cancer by equilibrating therapeutic magnetic nanoparticles throughout tumors. To evaluate the feasibility of DMS, histological liver sections from autopsy cases of women who died from breast neoplasms were studied to measure vessel number, size, and spatial distribution in both metastatic tumors and normal tissue. Consistent with prior studies, normal tissue had a higher vascular density with a vessel-to-nuclei ratio of 0.48 ± 0.14 (n = 1000), whereas tumor tissue had a ratio of 0.13 ± 0.07 (n = 1000). For tumors, distances from cells to their nearest blood vessel were larger (average 43.8 μm, maximum 287 μm, n ≈ 5500) than normal cells (average 5.3 μm, maximum 67.8 μm, n ≈ 5500), implying that systemically delivered nanoparticles diffusing from vessels into surrounding tissue would preferentially dose healthy instead of cancerous cells. Numerical simulations of magnetically driven particle transport based on the autopsy data indicate that DMS would correct the problem by increasing nanoparticle levels in hypovascular regions of metastases to that of normal tissue, elevating the time-averaged concentration delivered to the tumor for magnetic actuation versus diffusion alone by 1.86-fold, and increasing the maximum concentration over time by 1.89-fold. Thus, DMS may prove useful in facilitating therapeutic nanoparticles to reach poorly vascularized regions of metastatic tumors that are not accessed by diffusion alone. PMID:22131836

  14. An Autopsied Case of Malignant Sarcomatoid Pleural Mesothelioma in Which Chest Pain Developed Several Months Earlier without Abnormality on Imaging

    PubMed Central

    Yaguchi, Daizo; Ichikawa, Motoshi; Inoue, Noriko; Kobayashi, Daisuke; Matsuura, Akinobu; Shizu, Masato; Imai, Naoyuki; Watanabe, Kazuko

    2015-01-01

    The patient experienced chest pain for about 7 months, but a diagnosis could not be made until after death. He was diagnosed with malignant sarcomatoid pleural mesothelioma on autopsy. In this case report, difficult aspects of the diagnosis are discussed. The 70-year-old Japanese man was a driver who transported ceramic-related products. Right chest pain developed in July 2013, but no abnormality was detected on a chest computed tomography (CT) performed in September 2013, and the pain was managed as right intercostal neuralgia. A chest CT performed in late October 2013 revealed a right pleural effusion, and the patient was referred to our hospital in early November 2013. Thoracentesis was performed, but the cytology was negative, and no diagnosis could be made. Close examination was postponed because the patient developed a subarachnoid hemorrhage. He underwent 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) after discharge from the neurosurgery department, and extensive right pleural thickening and 18F-FDG accumulation in this region were observed. Based on these findings, malignant pleural mesothelioma was suspected, and a thoracoscopy was performed under local anesthesia in early December 2013, but no definite diagnosis could be made. The patient selected best supportive care and died about 7 months after the initial development of right chest pain. The disease was definitively diagnosed as malignant sarcomatoid pleural mesothelioma by a pathological autopsy. When chronic chest pain of unknown cause is observed and past exposure to asbestos is suspected, actions to prevent delay in diagnosis should be taken, including testing for suspicion of malignant pleural mesothelioma. PMID:26600776

  15. Immunohistochemical Analysis of Brainstem Lesions in the Autopsy Cases with Severe Motor and Intellectual Disabilities Showing Sudden Unexplained Death

    PubMed Central

    Hayashi, Masaharu; Sakuma, Hiroshi

    2016-01-01

    It is known that patients with severe motor and intellectual disabilities (SMID) showed sudden unexplained death (SUD), in which autopsy failed to identify causes of death. Although the involvement of brainstem dysfunction is speculated, the detailed neuropathological analysis still remains to be performed. In order to clarify pathogenesis, we investigated the brainstem functions in autopsy cases of SMID showing SUD. We immunohistochemically examined expressions of tyrosine hydroxylase, tryptophan hydroxylase, substance P, methionine-enkephalin, and c-fos in the serial sections of the midbrain, pons, and medulla oblongata in eight SUD cases and seven controls, having neither unexplained death nor pathological changes in the brain. Expressions of tyrosine hydroxylase and tryptophan hydroxylase were reduced in two of eight cases, and those of substance P and/or methionine-enkephalin were augmented in the pons and medulla oblongata in seven of eight cases, including the aforementioned two cases, when compared with those in controls. The hypoglossal nucleus and/or the dorsal vagal nucleus demonstrated increased neuronal immunoreactivity for c-fos in seven of eight cases, although there was no neuronal loss or gliosis in both the nuclei. Controls rarely showed immunoreactivity for c-fos in the medulla oblongata. These data suggest the possible involvement of brainstem dysfunction in SUD in patients with SMID, and consecutive neurophysiological evaluation of brainstem functions, such as all-night polysomnography and blink reflex, may be useful for the prevention of SUD, because some parameters in the neurophysiological examination are known to be related to the brainstem catecholamine neurons and the spinal tract nucleus of trigeminal nerve. PMID:27445960

  16. An Autopsied Case of Malignant Sarcomatoid Pleural Mesothelioma in Which Chest Pain Developed Several Months Earlier without Abnormality on Imaging.

    PubMed

    Yaguchi, Daizo; Ichikawa, Motoshi; Inoue, Noriko; Kobayashi, Daisuke; Matsuura, Akinobu; Shizu, Masato; Imai, Naoyuki; Watanabe, Kazuko

    2015-01-01

    The patient experienced chest pain for about 7 months, but a diagnosis could not be made until after death. He was diagnosed with malignant sarcomatoid pleural mesothelioma on autopsy. In this case report, difficult aspects of the diagnosis are discussed. The 70-year-old Japanese man was a driver who transported ceramic-related products. Right chest pain developed in July 2013, but no abnormality was detected on a chest computed tomography (CT) performed in September 2013, and the pain was managed as right intercostal neuralgia. A chest CT performed in late October 2013 revealed a right pleural effusion, and the patient was referred to our hospital in early November 2013. Thoracentesis was performed, but the cytology was negative, and no diagnosis could be made. Close examination was postponed because the patient developed a subarachnoid hemorrhage. He underwent (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) after discharge from the neurosurgery department, and extensive right pleural thickening and (18)F-FDG accumulation in this region were observed. Based on these findings, malignant pleural mesothelioma was suspected, and a thoracoscopy was performed under local anesthesia in early December 2013, but no definite diagnosis could be made. The patient selected best supportive care and died about 7 months after the initial development of right chest pain. The disease was definitively diagnosed as malignant sarcomatoid pleural mesothelioma by a pathological autopsy. When chronic chest pain of unknown cause is observed and past exposure to asbestos is suspected, actions to prevent delay in diagnosis should be taken, including testing for suspicion of malignant pleural mesothelioma. PMID:26600776

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

    PubMed Central

    2011-01-01

    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

  18. Verbal/social autopsy study helps explain the lack of decrease in neonatal mortality in Niger, 2007–2010

    PubMed Central

    Kalter, Henry D; Yaroh, Asma Gali; Maina, Abdou; Koffi, Alain K; Bensaïd, Khaled; Amouzou, Agbessi; Black, Robert E

    2016-01-01

    Background This study was one of a set of verbal/social autopsy (VASA) investigations undertaken by the WHO/UNICEF–supported Child Health Epidemiology Reference Group to estimate the causes and determinants of neonatal and child deaths in high priority countries. The study objective was to help explain the lack of decrease in neonatal mortality in Niger from 2007 to 2010, a period during which child mortality was decreasing. Methods VASA interviews were conducted of a random sample of 453 neonatal deaths identified by the 2010 Niger National Mortality Survey (NNMS). Causes of death were determined by expert algorithm analysis, and the prevalence of household, community and health system determinants were examined along the continuum of maternal and newborn care, the Pathway to Survival for newborn illnesses, and an extended pathway for maternal complications. The social autopsy findings were compared to available data for survivors from the same cohort collected by the NNMS and the 2012 Niger Demographic and Health Survey. Findings Severe neonatal infection and birth asphyxia were the leading causes of early neonatal death in the community and facilities. Death in the community after delayed careseeking for severe infection predominated during the late neonatal period. The levels of nearly all demographic, antenatal and delivery care factors were in the direction of risk for the VASA study decedents. They more often resided rurally (P < 0.001) and their mothers were less educated (P = 0.03) and gave birth when younger (P = 0.03) than survivors’ mothers. Their mothers also were less likely to receive quality antenatal care (P < 0.001), skilled attendance at birth (P = 0.03) or to deliver in an institution (P < 0.001). Nearly half suffered an obstetric complication, with more maternal infection (17.9% vs 0.2%), antepartum hemorrhage (12.5% vs 0.5%) and eclampsia/preeclampsia (9.5% vs 1.6%) than for all births in Niger. Their mothers also

  19. Social determinants of child mortality in Niger: Results from the 2012 National Verbal and Social Autopsy Study

    PubMed Central

    Koffi, Alain K; Maina, Abdou; Yaroh, Asma Gali; Habi, Oumarou; Bensaïd, Khaled; Kalter, Henry D

    2016-01-01

    Background Understanding the determinants of preventable deaths of children under the age of five is important for accelerated annual declines – even as countries achieve the UN’s Millennium Development Goals and the target date of 2015 has been reached. While research has documented the extent and nature of the overall rapid decline in child mortality in Niger, there is less clear evidence to provide insight into the contributors to such deaths. This issue is the central focus of this paper. Methods We analyzed a nationally representative cross–sectional sample of 620 child deaths from the 2012 Niger Verbal Autopsy/Social Autopsy (VASA) Survey. We conducted a descriptive analysis of the data on preventive and curative care, guided by the coverage of proven indicators along the continuum of well child care and illness recognition and care–seeking for child illnesses encompassed by the BASICS/CDC Pathway to Survival model. Results Six hundred twenty deaths of children (1–59 months of age) were confirmed from the VASA survey. The majority of these children lived in households with precarious socio–economic conditions. Among the 414 children whose fatal illnesses began at age 0–23 months, just 24.4% were appropriately fed. About 24% of children aged 12–59 months were fully immunized. Of 601 children tracked through the Pathway to Survival, 62.4% could reach the first health care provider after about 67 minutes travel time. Of the 306 children who left the first health care provider alive, 161 (52.6%) were not referred for further care nor received any home care recommendations, and just 19% were referred to a second provider. About 113 of the caregivers reported cost (35%), distance (35%) and lack of transport (30%) as constraints to care–seeking at a health facility. Conclusion Despite Niger’s recent major achievements in reducing child mortality, the following determinants are crucial to continue building on the gains the country has made

  20. Distribution of pseudoexfoliation material on anterior segment structures in human autopsy eyes after cataract surgery with intraocular lens implantation.

    PubMed

    Schmack, Ingo; Auffarth, Gerd Uwe

    2016-06-01

    The purpose of the study was to evaluate the distribution and amount of pseudoexfoliation material (PXM) on anterior segment structures in pseudophakic human autopsy eyes with pseudoexfoliation (PEX) syndrome and to study its impact on fixation and decentration of posterior chamber intraocular lenses (IOLs). Sixteen human autopsy eyes (donor age [mean ± SD] 77.5 ± 8.6 years; range, 70-90 years) with history of cataract surgery and PEX syndrome were analyzed for distribution and accumulation of PXM on structures of the anterior segment by light microscopy. Quantitative IOL decentration measurements were performed using the Miyake-Apple posterior view technique. All 16 eyes displayed IOLs which were either fixed symmetrically in the capsular bag (n = 8) or asymmetrically with one haptic in the sulcus and one in the bag (n = 7) or at the pars plicata of the ciliary body (n = 1). In the majority, PXM was found around the pars plicata (average grade: 1.6 ± 0.53 µm) and the lens capsule (average grade: 1.05 ± 0.46 µm). Minor amounts were detected at the pars plana and the trabecular meshwork. IOL decentration measurements ranged from 0.51 ± 0.35 (symmetrical-fixation) to 0.61 ± 0.43 mm (asymmetrical-fixation). There was only a weak statistically not significant correlation in regard to the amount of PXM and IOL decentration and between PXM distribution and the IOL fixation site. PXM contributes to weakening of the suspensory apparatus of the crystalline lens. Although PXM induced tissue alterations predispose for a broad spectrum of intra- and postoperative complications, the amount and distribution of PXM on different anterior segment structures showed only a weak correlation to IOL decentration or fixation location. PMID:26307751

  1. Verbal autopsy and therapeutic itinerary of children who die before arrival in a paediatric centre in Yaoundé, Cameroon

    PubMed Central

    Nguefack, Félicitée; Ntoude, Anicet; Soh, Florence; Ngou, Patrick; Koki Ndombo, Paul O.

    2016-01-01

    Background In Cameroon the rate of infant-juvenile mortality remains high and most death occur in the community. Mortality statistics is usually based on hospital data which are generally insufficient and less reliable. In a context where legislation on death registration is not applied, and where conventional autopsy is not often done, verbal autopsy (VA) provides information on mortality. This study tried to experiment this method and also analyses the therapeutic pathway of a group of children who died before arrival at the emergency department of a pediatric hospital. Methods A cross sectional descriptive study was carried out on children who died before arrival, at the Mother and Child Centre of the Chantal Biya Foundation in Yaounde, between October 2013 and April 2014. The addresses of parents or relatives of the deceased children were registered at the start of the study. Each respondent was interviewed 5 to 6 weeks later at the residence of the deceased child, with the aid of a VA questionnaire. Information obtained was on the socio-demographic characteristics of the families, past history of deceased, clinical presentation and the different health care services sought before the death. Results In all, 40 children who died were included in the study. The majority of the deceased children were less than 5 years (82.5%) with 50.0% being less than 1 year of age. Almost half of them (47.5%) had been ill for more than 24 hours, 40% for more than 3 days. Up to 50.0% had not been taken to a health facility. Most of them had visited 2 or 3 other health facilities before dying on the way to our hospital. Auto medication was frequent (42.5%); parents initially recourse to drugs which were either bought or obtained from home. Some parents (25.0%) brought their children only after they had been to a private dispensary, or a traditional healer (15.0%). Only 7.5% benefited from consultation in a public health facility and 2.5% resorted to prayers and incantations

  2. Human organ/tissue growth algorithms that include obese individuals and black/white population organ weight similarities from autopsy data.

    PubMed

    Young, John F; Luecke, Richard H; Pearce, Bruce A; Lee, Taewon; Ahn, Hongshik; Baek, Songjoon; Moon, Hojin; Dye, Daniel W; Davis, Thomas M; Taylor, Susan J

    2009-01-01

    Physiologically based pharmacokinetic (PBPK) models need the correct organ/tissue weights to match various total body weights in order to be applied to children and the obese individual. Baseline data from Reference Man for the growth of human organs (adrenals, brain, heart, kidneys, liver, lungs, pancreas, spleen, thymus, and thyroid) were augmented with autopsy data to extend the describing polynomials to include the morbidly obese individual (up to 250 kg). Additional literature data similarly extends the growth curves for blood volume, muscle, skin, and adipose tissue. Collectively these polynomials were used to calculate blood/organ/tissue weights for males and females from birth to 250 kg, which can be directly used to help parameterize PBPK models. In contrast to other black/white anthropomorphic measurements, the data demonstrated no observable or statistical difference in weights for any organ/tissue between individuals identified as black or white in the autopsy reports. PMID:19267313

  3. Postmortem clinical examination by experienced clinical geneticists as an alternative to conventional autopsy for assessment of fetal and perinatal deaths in countries with limited resources.

    PubMed

    Abdalla, Ebtesam M; El Desouky, Lubna M; Hassanein, Nargues M

    2015-01-01

    The aim of this study was to investigate the usefulness of postmortem external examination performed by an experienced clinical geneticist as an alternative to autopsy in countries with limited resources. We studied a consecutive cohort of couples seeking genetic counseling for fetal loss or perinatal death over a period of 3 years. The study involved 230 couples; only 57 of them submitted a fetus or dead neonate, for whom a meticulous postmortem clinical examination was performed by an experienced clinical geneticist. The diagnosis rate for the group of cases subjected to postmortem examination (57.9%) was much higher than that of the group that comprised cases for which diagnosis was made through evaluation of medical records (27.2%). Whenever fetal or neonatal autopsy is refused or is not feasible, a comprehensive fetal or perinatal postmortem external examination by an experienced clinical geneticist may be a reasonable substitute. PMID:26690595

  4. [External and internal post mortem examination according to the german code of criminal procedure (StPO)--review of section 87 StPO with special emphasis on the forensic autopsy].

    PubMed

    Parzeller, Markus; Dettmeyer, Reinhard; Bratzke, Hansjürgen

    2009-01-01

    Section 87 subs. 2 of the German Code of Criminal Procedure stipulates that a forensic or court-ordered autopsy shall be performed by two physicians. One of them must be a "forensic medical officer" (in German "Gerichtsarzt") or the head of a public forensic or pathology institute or a physician of such an institute entrusted with this task and having specialist knowledge of forensic medicine. Recently, it has been suggested to amend Section 87 subs. 2 StPO to the effect that self-employed specialists in forensic medicine can also be entrusted with court-ordered autopsies. The authors object to such privatization of forensic autopsies for legal and factual reasons and recommend to keep the present regulation according to which one of the physicians conducting the autopsy is not only required to have the necessary professional qualification, but must also hold a public position as defined in the law. PMID:19323147

  5. Fatal Case of Hydrocarbon Aspiration and Use of Lipoid Cells as Corroborative Finding for Rapid Autopsy Diagnosis in Cases of Delayed Death

    PubMed Central

    Jaybhaye, Prasad L.; Shilawant, Santosh S.

    2014-01-01

    Accidental aspiration of diesel can cause consolidation, atelectasis, and abscess formation. Aspiration of diesel usually results into pneumonitis, which resolves completely within 5–7 days of treatment. Diesel aspiration resulting in bilateral pneumonia and death is rare and is scarcely documented in literature. Finding of lipoid cells in lung autopsy specimen is one of the important features of hydrocarbon aspiration. Unfortunately this important finding is not mentioned in most of the toxicology textbooks. Hence, we are reporting this case. PMID:25948973

  6. Fatal case of hydrocarbon aspiration and use of lipoid cells as corroborative finding for rapid autopsy diagnosis in cases of delayed death.

    PubMed

    Jaybhaye, Prasad L; Shilawant, Santosh S

    2014-01-01

    Accidental aspiration of diesel can cause consolidation, atelectasis, and abscess formation. Aspiration of diesel usually results into pneumonitis, which resolves completely within 5-7 days of treatment. Diesel aspiration resulting in bilateral pneumonia and death is rare and is scarcely documented in literature. Finding of lipoid cells in lung autopsy specimen is one of the important features of hydrocarbon aspiration. Unfortunately this important finding is not mentioned in most of the toxicology textbooks. Hence, we are reporting this case. PMID:25948973

  7. Detection of Merkel cell polyomavirus in the human tissues from 41 Japanese autopsy cases using polymerase chain reaction.

    PubMed

    Matsushita, Michiko; Kuwamoto, Satoshi; Iwasaki, Takeshi; Higaki-Mori, Hiromi; Yashima, Shoji; Kato, Masako; Murakami, Ichiro; Horie, Yasushi; Kitamura, Yukisato; Hayashi, Kazuhiko

    2013-01-01

    It has recently been shown that approximately 80% of Merkel cell carcinomas harbor a novel polyomavirus named Merkel cell polyomavirus (MCPyV). MCPyV has been detected in human tissue samples. However, detailed distribution of MCPyV in non-neoplastic Japanese human tissues remains unclear. To address this, we used single or real-time quantitative polymerase chain reaction (PCR) for 41 autopsy cases. PCR revealed MCPyV-DNA in non-neoplastic samples: total, 29/41 (71%); adult, 29/39 (74%); fetus or infant, 0/2; men, 24/28 (86%); women, 5/13 (38%); total human tissues, 66/572 (12%); skin, 8/15 (53%); adrenal gland, 9/33 (27%), and other 16 organs (4-25%). This study first reported the presence of MCPyV-DNA in non-neoplastic tissues of thyroid gland, adrenal gland, spleen, bone marrow, stomach, gallbladder, pancreas, heart, and aorta. PCR revealed that viral load ranged from 0.00026 to 0.22 in all MCPyV-positive tissues compared with Merkel cell carcinoma samples. These detailed PCR data showed higher prevalence of MCPyV infection in Japanese men than women (p = 0.004) and broad distribution of MCPyV with low viral load in more non-neoplastic human tissues than in the previous reports. These data provide valuable insights for further studies of MCPyV infection and MCPyV-related diseases. PMID:22986833

  8. TARDBP 3′-UTR variant in autopsy-confirmed frontotemporal lobar degeneration with TDP-43 proteinopathy

    PubMed Central

    Gitcho, Michael A.; Bigio, Eileen H.; Mishra, Manjari; Johnson, Nancy; Weintraub, Sandra; Mesulam, Marsel; Rademakers, Rosa; Chakraverty, Sumi; Cruchaga, Carlos; Morris, John C.; Goate, Alison M.

    2009-01-01

    Pathogenic mutations in the gene encoding TDP-43, TARDBP, have been reported in familial amyotrophic lateral sclerosis (FALS) and, more recently, in families with a heterogeneous clinical phenotype including both ALS and frontotemporal lobar degeneration (FTLD). In our previous study, sequencing analyses identified one variant in the 3′-untranslated region (3′-UTR) of the TARDBP gene in two affected members of one family with bvFTD and ALS and in one unrelated clinically assessed case of FALS. Since that study, brain tissue has become available and provides autopsy confirmation of FTLD-TDP in the proband and ALS in the brother of the bvFTD-ALS family and the neuropathology of those two cases is reported here. The 3′-UTR variant was not found in 982 control subjects (1,964 alleles). To determine the functional significance of this variant, we undertook quantitative gene expression analysis. Allele-specific amplification showed a significant increase of 22% (P < 0.05) in disease-specific allele expression with a twofold increase in total TARDBP mRNA. The segregation of this variant in a family with clinical bvFTD and ALS adds to the spectrum of clinical phenotypes previously associated with TARDBP variants. In summary, TARDBP variants may result in clinically and neuropathologically heterogeneous phenotypes linked by a common molecular pathology called TDP-43 proteinopathy. PMID:19618195

  9. GC-MS identification of MIC trimer: a constituent of tank residue in preserved autopsy blood of Bhopal gas victims.

    PubMed

    Chandra, H; Rao, G J; Saraf, A K; Sharma, V K; Jadhav, R K; Sriramachari, S

    1991-10-01

    Based on the external and internal findings of Bhopal gas disaster victims, it was apparent that the gases and particulate matter came out as an aerosol. This was possibly the pyrolysed, reformulated, reconjugated suspension of constituents of the tank E-610 of Union Carbide India Limited, Bhopal, while it was claimed to be methyl isocyanate (MIC) only. It was postulated by the manufacturer of MIC, that the material inhaled by the victims of the Bhopal gas disaster does not cross the lung barrier (UCC press conference on 14th December 1984). It was observed that the more the victims ran, the more aerosol they inhaled and the fatalities were observed in such victims. The tissues, which were preserved in the deep freeze, were randomly selected and analysed by GC coupled with MS (ITD) Finnigan MAT, UK. 14 out of 34 autopsy cases showed MIC trimer peak in extracts of blood. This was one of the constituents of the aerosol and was also located in the tank residue, thereby proving that the trimer had passed the lung barrier. PMID:1795611

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

    PubMed

    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

  11. Cerebral Cortical Aβ42 and PHF-τ in 325 Consecutive Brain Autopsies Varies by Diagnosis, Location, and APOE

    PubMed Central

    Postupna, Nadia; Keene, C. Dirk; Crane, Paul K.; Gonzalez-Cuyar, Luis F.; Sonnen, Joshua A.; Hewitt, Jessica; Rice, Samantha; Howard, Kimberly; Montine, Kathleen S.; Larson, Eric B.; Montine, Thomas J.

    2014-01-01

    We used a novel approach for molecular quantification in standard fixed and embedded tissue to measure Aβ42 and paired helical filament-τ) (PHF-τ) in frontal, temporal, and parietal cortex from 325 consecutive brain autopsies collected as part of a population-based study of brain aging and incident dementia in the Seattle area. We observed significant effects of APOE ε4 on Aβ42 levels in both diagnostic groups by disease stage and region. In contrast, we did not observe a significant effect of APOE ε4 on PHF-τ levels by disease stage in any region. Aβ42 and PHF-τ levels in cerebral cortex were correlated more strongly in the Dementia group, and these measures had independent explanatory power for dementia beyond those of standard neuropathologic indices. Associations between Lewy body disease and levels of Aβ42 or PHF-τ and between Aβ42 levels and microvascular brain injury suggested that these co-morbid diseases enhanced the penetrance of AD. Our novel approach brings additional insights into the molecular pathogenesis of common causes of dementia and may serve as a platform for future studies that pursue associations between molecular changes of AD and genetic or environmental risk. PMID:25575135

  12. Intrahepatic cholangiocarcinoma in a worker at an offset color proof-printing company: An autopsy case report.

    PubMed

    Tomimaru, Yoshito; Kobayashi, Shogo; Wada, Hiroshi; Hama, Naoki; Kawamoto, Koichi; Eguchi, Hidetoshi; Kira, Toshihiko; Morii, Eiichi; Doki, Yuichiro; Mori, Masaki; Nagano, Hiroaki

    2015-04-01

    A 40-year-old Japanese man visited our hospital after test results indicated elevated hepatobiliary enzymes. He had worked at a printing plant for 8 years and been exposed to organic solvents, including 1,2-dichloropropane (1,2-DCP) and dichloromethane (DCM). Abdominal computed tomography (CT) showed an intrahepatic tumor with dilation of the intrahepatic bile duct. He was diagnosed with intrahepatic cholangiocarcinoma. He had no known risk factors for cholangiocarcinoma. Extended left hepatectomy with lymph node dissection was performed and the tumor was histologically diagnosed as well-differentiated adenocarcinoma. A histological examination also showed biliary intraepithelial preneoplastic lesions in non-cancerous liver areas. Two years after surgery, the patient developed jaundice, esophageal varices and ascites. A CT examination showed liver cirrhosis without recurrence of the cholangiocarcinoma. Although a liver transplantation was planned as a therapeutic option for his liver cirrhosis, his liver failure progressed rapidly and he died before transplantation could be performed. At autopsy, fibrosis was found in the whole liver, especially in the wall of the bile duct and periductal area suggesting chronic bile duct injury due to exposure to organic solvents. Taken together, the current case may suggest that exposure to organic solvents, including 1,2-DCP and DCM, is a risk factor for cholangiocarcinoma. Identifying risk factors for cholangiocarcinoma will help identify the mechanism and help prevent development of the disease. PMID:24849871

  13. Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography

    PubMed Central

    Bai, Ya; Song, Wen; Chen, Yongchao; Li, Dongxue; Han, Hui; Liu, Bin

    2015-01-01

    Purpose Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV). Methods Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared. Results Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented. Conclusion The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery. PMID:26658152

  14. Completed Suicide with Violent and Non-Violent Methods in Rural Shandong, China: A Psychological Autopsy Study

    PubMed Central

    Sun, Shi-Hua; Jia, Cun-Xian

    2014-01-01

    Background This study aims to describe the specific characteristics of completed suicides by violent methods and non-violent methods in rural Chinese population, and to explore the related factors for corresponding methods. Methods Data of this study came from investigation of 199 completed suicide cases and their paired controls of rural areas in three different counties in Shandong, China, by interviewing one informant of each subject using the method of Psychological Autopsy (PA). Results There were 78 (39.2%) suicides with violent methods and 121 (60.8%) suicides with non-violent methods. Ingesting pesticides, as a non-violent method, appeared to be the most common suicide method (103, 51.8%). Hanging (73 cases, 36.7%) and drowning (5 cases, 2.5%) were the only violent methods observed. Storage of pesticides at home and higher suicide intent score were significantly associated with choice of violent methods while committing suicide. Risk factors related to suicide death included negative life events and hopelessness. Conclusions Suicide with violent methods has different factors from suicide with non-violent methods. Suicide methods should be considered in suicide prevention and intervention strategies. PMID:25111835

  15. Monitoring metals in the population living in the vicinity of a hazardous waste incinerator: concentrations in autopsy tissues.

    PubMed

    Bocio, Ana; Nadal, Martí; Garcia, Francisco; Domingo, Jose L

    2005-07-01

    This study is a part of a monitoring program for the determination of metals in various human tissues of the population living in the vicinity of a new hazardous waste incinerator (HWI) in Constantí (Tarragona County, Spain). Concentrations of arsenic (As), beryllium (Be), cadmium (Cd), chromium (Cr), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), tin (Sn), thallium (Tl), and vanadium (V) were determined in brain, bone, kidney, liver, and lung autopsy samples collected in 2003 from 22 individuals who had been living for at least 10 yr in the area under evaluation. Results were compared with the metal levels obtained in a baseline study, which was performed during the construction of the HWI (1996--1998). In the present survey, As, Be, Tl, and V levels were not detected in any of the analyzed tissues, while Cr concentrations were very close to the limit of detection. The highest levels of Cd and Hg were found in kidney (17.46 microg/g and 0.23 microg/g, respectively), those of Mn in liver (1.07 microg/g), and those of Ni, Pb, and Sn in bone (1.16 microg/g, 2.11 microg/g, and 0.34 microg/g, respectively). In comparison to the results of the baseline study, a general reduction of most metal concentrations was observed in the current survey. PMID:16037609

  16. "Gliomatosis encephali" as a novel category of brain tumors by the first autopsy case report of gliomatosis cerebelli.

    PubMed

    Nakahara, Asa; Yoshida, Toshikazu; Yazawa, Masanobu; Ehara, Takashi; Nakayama, Jun; Kakita, Akiyoshi; Ogura, Ryosuke; Asakawa, Mika; Suzuki-Kouyama, Emi; Oyanagi, Kiyomitsu

    2014-06-01

    Gliomatosis cerebri is a rare diffuse glioma that is neither mass-forming nor necrotic, and does not disrupt existing structures. Gliomatosis occurring in the cerebellum is known as gliomatosis cerebelli, and only three such cases examined by biopsy have been reported. Here we describe the first autopsy findings of a patient who was diagnosed as having gliomatosis in the cerebellum. Neuropathological examination identified the tumor cells as being positive for glial fibrillary acidic protein, vimentin and nestin, with atypical nuclei that were cashew-nut- or dishcloth-gourd-shaped. These tumor cells were dense in the right cerebellum, but also spread broadly throughout the brain including the left cerebrum and optic nerve. Mitotic figures were frequently seen in the cerebellum, brain stem and cerebrum. Scherer's secondary structures were evident not only in the cerebellum but also the cerebrum. No necrosis, microvascular proliferation or destruction of anatomical structures was detected in the whole brain. Differences in the origin of the tumors of the gliomatoses cerbri and cerebelli suggests these tumors are different types of brain tumors. Thus the findings support that the gliomatosis cerebelli is a novel type of brain tumor classification. Furthermore, by the similarities of the histological features among the tumors, it appears appropriate to establish a novel category of "gliomatosis encephali" which includes both gliomatosis cerebri and gliomatosis cerebelli. PMID:24354431

  17. [An autopsied case of chronic active Epstein-Barr virus infection complicated in systemic lupus erythematosus and antiphospholipid antibody syndrome].

    PubMed

    Ogawa, Jun; Koike, Ryuji; Sugihara, Takahiko; Hagiyama, Hiroyuki; Nishio, Junko; Kohsaka, Hitoshi; Kubota, Tetsuo; Kawachi, Hiroshi; Kasahara, Ichiro; Miyasaka, Nobuyuki

    2002-12-01

    We have experienced a case of chronic active Epstein-Barr virus infection (CAEBV) complicated in systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS). A 35-year-old woman was admitted to our hospital with complaints of fever and dyspnea on exertion. She was diagnosed as having SLE on the basis of arthritis, oropharyngeal ulcer, lymphopenia, and positive autoantibodies against DNA, RNP and SSA. The diagnosis of APS was also made because of positive anti-cardiolipin IgG antibodies and the existence of multiple pulmonary infarction with pulmonary hypertension. The administration of 30 mg/day of prednisolone and anti-coagulation significantly improved clinical symptoms. However, she was again admitted to the hospital four months later because of progressive liver damage and pancytopenia. Increment of prednisolone did not improve the clinical situation and she expired because of pulmonary hemorrhage. At autopsy, there were a significant increase of histiocytes with hemophagocytosis and a dense infiltration of atypical lymphocytes in the liver, spleen, lymph nodes and bone marrow. Infiltrated lymphocytes were positive for CD 3 and EBER 1 in immunohistochemical staining and EBVmRNA was detected by in situ hybridization. Final pathological diagnosis was CAEBV with hemophagocytic syndrome in association with lupus nephritis, pulmonary hemorrhage and pulmonary infarction. PMID:12599514

  18. Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy.

    PubMed

    Ishikawa, Takaki; Quan, Li; Michiue, Tomomi; Kawamoto, Osamu; Wang, Qi; Chen, Jian-Hua; Zhu, Bao-Li; Maeda, Hitoshi

    2013-05-10

    Previous studies have suggested that postmortem serum catecholamine levels reflect the magnitude of physical stress responses or toxic/hyperthermic neuronal dysfunction during the death process. The present study investigated postmortem adrenaline (Adr), noradrenaline (Nad), and dopamine (DA) levels in pericardial fluid (PCF) and cerebrospinal fluid (CSF) with regard to the cause of death, compared with right heart blood levels, in serial medicolegal autopsy cases with a postmortem time within 48 h (n=494). Correlations between PCF and CSF Adr levels, and those among right heart blood, PCF, and CSF DA levels were marked (r=0.66-0.83, p<0.0001), but were otherwise lower (r=0.22-0.44). With regard to the cause of death, Adr and Nad levels in PCF, CSF, and right heart blood mostly presented similar findings: these levels were generally high in injury, intoxication, and hyperthermia (heatstroke), but were low in hypothermia (cold exposure). DA levels at each site were higher in injury and intoxication. In addition, higher levels were detected for Nad levels in sharp instrument injury, as well as Adr, Nad, and DA in carbon monoxide intoxication at each site, and for CSF Nad in psychotropic drug intoxication. These findings suggest that characteristic elevations in Adr, Nad, and DA levels in PCF and CSF are involved in systemic responses to fatal stress and toxic neuronal dysfunction, reflecting the magnitude of such responses in individual cases. PMID:23597740

  19. Sclerosing encapsulating peritonitis (abdominal cocoon) associated with liver cirrhosis and diffuse large B-cell lymphoma: autopsy case.

    PubMed

    Yamada, Sohsuke; Tanimoto, Akihide; Matsuki, Yasumasa; Hisada, Yuji; Sasaguri, Yasuyuki

    2009-09-01

    A case of sclerosing encapsulating peritonitis (SEP) associated with liver cirrhosis (LC) and complicated by diffuse large B-cell lymphoma (DLBCL) is reported herein. A 49-year-old Japanese man had undergone peritoneo-venous shunt against refractory ascites due to hepatitis C virus-positive uncompensated LC for 2 years. After he received a diagnosis of DLBCL of the left neck lymph node 3 months before his death, palliative care was given because of his poor general condition. He developed severe abdominal distention and pain over 1 week and was found to have marked ascites and whole bowel lumped together on abdominal CT. At autopsy, the peritoneum was covered with a thick white membrane and the bowel could not be distinguished, which was macroscopically characterized by a cocoon-like appearance. Histology indicated a proliferation of diffusely thickened or hyalinized fibrocollagenous tissue in the entire peritoneum with a slight chronic inflammatory infiltrate and without remarkable change of mucosa. A diagnosis of SEP, also known as abdominal cocoon, was established based on these features. Additionally, in the abdominal cavity, a large amount of serous ascites and multiple peritoneal nodules or masses involved by DLBCL were recognized. To the authors' knowledge this is the first case report of SEP associated with LC and complicated by the invasion of DLBCL in the abdominal cavity. PMID:19712139

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

    PubMed

    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

  1. Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics.

    PubMed Central

    Setel, Philip W.; Sankoh, Osman; Rao, Chalapati; Velkoff, Victoria A.; Mathers, Colin; Gonghuan, Yang; Hemed, Yusuf; Jha, Prabhat; Lopez, Alan D.

    2005-01-01

    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 despite 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. PMID:16184280

  2. Molecular pathology of pulmonary edema in forensic autopsy cases with special regard to fatal hyperthermia and hypothermia.

    PubMed

    Wang, Qi; Ishikawa, Takaki; Michiue, Tomomi; Zhu, Bao-Li; Guan, Da-Wei; Maeda, Hitoshi

    2013-05-10

    Fatalities due to an extreme ambient temperature might present with poor or nonspecific pathologies; thus, the diagnosis of the cause of death in such cases is one of the most difficult tasks in forensic pathology. The present study investigated the molecular pathology of alveolar damage involving pulmonary edema with special regard to hyperthermia (heatstroke) and hypothermia (cold exposure) in forensic autopsy cases (total, n=122; within 48 h postmortem). Intrapulmonary mRNA and immunohistochemical expressions of matrix metalloproteinases (MMPs), intercellular adhesion molecule-1 (ICAM-1), claudin-5 (CLDN-5) and aquaporins (AQPs) were examined. Relative mRNA quantification using Taqman real-time PCR assay demonstrated higher expressions of all markers except for AQP-5 in fatal hyperthermia, and higher expression of MMP-9 in fatal hypothermia. Acute cardiac death, mechanical asphyxiation, fire fatality and intoxication did not present any characteristic findings. In immunostaining, only MMPs showed evident differences among the causes of death: MMP-9 was intensely positive in most cases of hyperthermia and hypothermia, but MMP-2 expression was evident only in hyperthermia. These findings suggest alveolar damage involving pulmonary edema, characteristic of fatal hyperthermia and hypothermia. Systematic analysis of gene expressions using real-time PCR might be a useful procedure in forensic death investigation. PMID:23597750

  3. Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model.

    PubMed Central

    Fantahun, Mesganaw; Fottrell, Edward; Berhane, Yemane; Wall, Stig; Högberg, Ulf; Byass, Peter

    2006-01-01

    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 interpreting 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. PMID:16583079

  4. Streptococcus agalactiae infective endocarditis complicated by large vegetations at aortic valve cusps along with intracoronary extension: An autopsy case report.

    PubMed

    Ro, Ayako

    2016-01-01

    Streptococcus agalactiae infective endocarditis is a rare condition with high mortality owing to complications of large vegetations and systemic emboli. A 49-year-old man was found dead in his house. He had a history of hepatic cirrhosis and had been diagnosed with type 2 diabetes 2years previously. He had presented with a high fever 10days before his death. An autopsy revealed 50mL of purulent pericardial effusion, and S. agalactiae was detected from the culture of this pericardial effusion. Two slender rope-like vegetations were present at the right aortic valve cusp and noncoronary aortic valve cusp. The vegetation at the right aortic valve cusp extended into the right coronary artery. The right coronary artery was broadly occluded by white rod-like material. The mitral valves were also affected, and the posterior papillary muscle was ruptured. Myocardial infarction was not observed. Systemic microscopic Gram-positive bacterial masses were observed in several organs. The death was attributed to acute myocardial ischemia caused by occlusive intracoronary extension of the vegetation at the proximal right coronary artery. PMID:26926519

  5. Distribution of volumes of individual glomeruli in kidneys at autopsy: association with physical and clinical characteristics and with ethnic group.

    PubMed

    Hoy, Wendy E; Hughson, Michael D; Diouf, Boucar; Zimanyi, Monika; Samuel, Terence; McNamara, Bridgette J; Douglas-Denton, Rebecca N; Holden, Libby; Mott, Susan A; Bertram, John F

    2011-01-01

    We have demonstrated considerable variability in the volumes of different glomeruli in given individuals (individual glomerular volume: IGV) in a stereologic study of kidneys at forensic autopsy performed to investigate sudden or unexpected death in people without manifest kidney disease. We review some important associations of IGV by subject characteristics and by ethnic groups. IGVs were measured by the Cavalieri method in 30 glomeruli in each of 111 adult males who belonged to 4 ethnic groups, i.e. US Whites, African-Americans, Africans from Senegal, and Australian Aborigines. Correlations of pooled IGV values with certain subject characteristics were evaluated in the US Whites. Pooled IGV data were compared in subjects across the 4 ethnic groups. In US Whites, mean IGV and its variance were greater with higher age, lower nephron number, lower birth weight, and with gross obesity, hypertension and cardiovascular death. In comparisons by ethnic group, mean IGV and IGV ranges were higher in African-Americans and Australian Aborigines than in US Whites and African Senegalese subjects. We conclude that glomerular enlargement with volume heterogeneity marks more advanced age, relative nephron deficiency, lower birth weight, obesity, hypertension, and advanced cardiovascular disease. The findings in African-Americans and Australian Aborigines suggest that larger IGVs and volume heterogeneity might mark populations with accentuated susceptibility to hypertension and kidney disease, but the data need to be further examined in the context of the determining characteristics defined in the US Whites. PMID:21659730

  6. Postmortem serotonin levels in cerebrospinal and pericardial fluids with regard to the cause of death in medicolegal autopsy.

    PubMed

    Quan, Li; Ishikawa, Takaki; Hara, Junpei; Michiue, Tomomi; Chen, Jian-Hua; Wang, Qi; Zhu, Bao-li; Maeda, Hitoshi

    2011-03-01

    Serotonin (5-hydroxytryptamine, 5-HT) is a neurotransmitter in the central nervous system (CNS) and a smooth muscle regulator in the cardiovascular and gastrointestinal systems. The present study investigated postmortem 5-HT levels in cerebrospinal fluid (CSF) and pericardial fluid (PCF) with regard to the cause of death in serial medicolegal autopsy cases within 48 h postmortem (n=351, >20 years of age). CSF and PCF 5-HT slightly increased during the postmortem period (r=0.298 and 0.253, respectively, p<0.001), showing no gender-related difference. The CSF level decreased depending on the subject age (r=0.497, p<0.001); however, the CSF and PCF levels showed similar findings with regard to the cause of death: these levels were significantly higher for sedative-hypnotic drug intoxication and hyperthermia (heat stroke), but lower for blunt head injury and hypothermia (cold exposure); the cutoff value was estimated as 25.5 ng/ml and 5.0 ng/ml, respectively. For other cause of death groups, some cases showed a higher level. These findings suggest elevations in CSF and PCF 5-HT levels due to systemic toxic or hyperthermic neuronal dysfunction, and systemic stress responses to trauma without CNS involvement. PMID:21185763

  7. Postmortem CT is more accurate than clinical diagnosis for identifying the immediate cause of death in hospitalized patients: a prospective autopsy-based study.

    PubMed

    Inai, Kunihiro; Noriki, Sakon; Kinoshita, Kazuyuki; Sakai, Toyohiko; Kimura, Hirohiko; Nishijima, Akihiko; Iwasaki, Hiromichi; Naiki, Hironobu

    2016-07-01

    Despite 75 to 90 % physician accuracy in determining the underlying cause of death, precision of determination of the immediate cause of death is approximately 40 %. In contrast, two thirds of immediate causes of death in hospitalized patients are correctly diagnosed by postmortem computed tomography (CT). Postmortem CT might provide an alternative approach to verifying the immediate cause of death. To evaluate the effectiveness of postmortem CT as an alternative method to determine the immediate cause of death in hospitalized patients, an autopsy-based prospective study was performed. Of 563 deaths from September 2011 to August 2013, 50 consecutive cadavers undergoing hospital autopsies with consent for additional postmortem CT at the University of Fukui were enrolled. The accuracy of determination of the immediate cause of death by postmortem CT was evaluated in these patients. Diagnostic discrepancy was also compared between radiologists and attending physicians. The immediate cause of death was correctly diagnosed in 37 of 50 subjects using postmortem CT (74 %), concerning 29 cases of respiratory failure, 4 of hemorrhage, 3 of liver failure and 1 of septic shock. Six cases of organ failure involving 13 patients were not identified as the cause of death by postmortem CT. Regarding the immediate cause of death, accuracy of clinical diagnosis was significantly lower than that of postmortem CT (46 vs 74 %, P < 0.01). Postmortem CT may be more useful than clinical diagnosis for identifying the immediate cause of death in hospitalized patients not undergoing autopsy. PMID:27085336

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

    PubMed Central

    Rohrbach, Markus; Lüem, Martin; Ochsner, Peter E

    2008-01-01

    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

  9. Comparing verbal autopsy cause of death findings as determined by physician coding and probabilistic modelling: a public health analysis of 54 000 deaths in Africa and Asia

    PubMed Central

    Byass, Peter; Herbst, Kobus; Fottrell, Edward; Ali, Mohamed M.; Odhiambo, Frank; Amek, Nyaguara; Hamel, Mary J.; Laserson, Kayla F.; Kahn, Kathleen; Kabudula, Chodziwadziwa; Mee, Paul; Bird, Jon; Jakob, Robert; Sankoh, Osman; Tollman, Stephen M.

    2015-01-01

    Background Coverage of civil registration and vital statistics varies globally, with most deaths in Africa and Asia remaining either unregistered or registered without cause of death. One important constraint has been a lack of fit–for–purpose tools for registering deaths and assigning causes in situations where no doctor is involved. Verbal autopsy (interviewing care–givers and witnesses to deaths and interpreting their information into causes of death) is the only available solution. Automated interpretation of verbal autopsy data into cause of death information is essential for rapid, consistent and affordable processing. Methods Verbal autopsy archives covering 54 182 deaths from five African and Asian countries were sourced on the basis of their geographical, epidemiological and methodological diversity, with existing physician–coded causes of death attributed. These data were unified into the WHO 2012 verbal autopsy standard format, and processed using the InterVA–4 model. Cause–specific mortality fractions from InterVA–4 and physician codes were calculated for each of 60 WHO 2012 cause categories, by age group, sex and source. Results from the two approaches were assessed for concordance and ratios of fractions by cause category. As an alternative metric, the Wilcoxon matched–pairs signed ranks test with two one–sided tests for stochastic equivalence was used. Findings The overall concordance correlation coefficient between InterVA–4 and physician codes was 0.83 (95% CI 0.75 to 0.91) and this increased to 0.97 (95% CI 0.96 to 0.99) when HIV/AIDS and pulmonary TB deaths were combined into a single category. Over half (53%) of the cause category ratios between InterVA–4 and physician codes by source were not significantly different from unity at the 99% level, increasing to 62% by age group. Wilcoxon tests for stochastic equivalence also demonstrated equivalence. Conclusions These findings show strong concordance between InterVA–4 and

  10. Targeted next generation sequencing application in cardiac channelopathies: Analysis of a cohort of autopsy-negative sudden unexplained deaths.

    PubMed

    Farrugia, A; Keyser, C; Hollard, C; Raul, J S; Muller, J; Ludes, B

    2015-09-01

    Genetic testing for cardiac channelopathies in sudden unexplained death (SUD) has developed substantially over the last years. The Next Generation Sequencing (NGS) technology provides an unprecedented opportunity to screen for genetic variations underlying arrhythmogenic genes in a short period of time at a low cost. The present study aimed to perform genetic testing with NGS technologies on the Ion Torrent Personal Genome Machine™ (Ion PGM™) sequencer, in targeting a total of 23 genes reported to be associated with inherited cardiac channelopathies in order to identify the possible cause of death in a cohort of post-mortem cases. The molecular analyses focused on 16 cases of SUD, aged less than 35 years old. In all cases, the cause of death could not be determined after a rigorous autopsy associated with histopathological and toxicological analyses according to the guidelines of the Association for European Cardiovascular Pathology. DNA was extracted from fresh frozen tissue. An average of 200 variants was identified per case. However, after the prioritization process using a new scoring program (VaRank) and after the conjunction of clinical data and molecular findings, four "likely pathogenic" variants (including two undescribed variants), were identified in three cases (18.75%) of our cohort in the genes KCNH2, ANK2, SCN5A and RYR2. One case, who died during psychiatric hospitalization after administration of a QT prolonging drug, showed a double "likely pathogenic" variant in Long QT genes (ANK2 and SCN5A) which may have predisposed to drug-induced cardiac arrhythmias. Our study illustrates that the NGS approach based on AmpliSeq™ libraries and Ion Torrent PGM™ sequencing may be an efficient approach, integrated to post-mortem examination. Given the massive amount of information generated by NGS, a rigorous filtration strategy of variants coupled with multidisciplinary collaboration is crucial to determine the potential pathogenic role of identified

  11. Reliability of reporting of HIV status and antiretroviral therapy usage during verbal autopsies: a large prospective study in rural Malawi

    PubMed Central

    Mclean, Estelle M.; Chihana, Menard; Mzembe, Themba; Koole, Olivier; Kachiwanda, Lackson; Glynn, Judith R.; Zaba, Basia; Nyirenda, Moffat; Crampin, Amelia C.

    2016-01-01

    Objective Verbal autopsies (VAs) are interviews with a relative or friend of the deceased; VAs are a technique used in surveillance sites in many countries with incomplete death certification. The goal of this study was to assess the accuracy and validity of data on HIV status and antiretroviral therapy (ART) usage reported in VAs and their influence on physician attribution of cause of death. Design This was a prospective cohort study. Methods The Karonga Health and Demographic Surveillance Site monitors demographic events in a population in a rural area of northern Malawi; a VA is attempted on all deaths reported. VAs are reviewed by clinicians, who, with additional HIV test information collected pre-mortem, assign a cause of death. We linked HIV/ART information reported by respondents during adult VAs to database information on HIV testing and ART use and analysed agreement using chi-square and kappa statistics. We used multivariable logistic regression to analyse factors associated with agreement. Results From 2003 to 2014, out of a total of 1,952 VAs, 80% of respondents reported the HIV status of the deceased. In 2013–2014, this figure was 99%. Of those with an HIV status known to the study, there was 89% agreement on HIV status between the VA and pre-mortem data, higher for HIV-negative people (92%) than HIV-positive people (83%). There was 84% agreement on whether the deceased had started ART, and 72% of ART initiation dates matched within 1 year. Conclusions In this population, HIV/ART information was often disclosed during a VA and matched well with other data sources. Reported HIV/ART status appears to be a reliable source of information to help classification of cause of death. PMID:27293122

  12. An autopsied case of sporadic adult-onset amyotrophic lateral sclerosis with FUS-positive basophilic inclusions.

    PubMed

    Matsuoka, Takeshi; Fujii, Naoki; Kondo, Akira; Iwaki, Akiko; Hokonohara, Toshihiro; Honda, Hiroyuki; Sasaki, Kensuke; Suzuki, Satoshi O; Iwaki, Toru

    2011-02-01

    Basophilic inclusions (BIs), which are characterized by their staining properties of being weakly argyrophilic, reactive with Nissl staining, and immunohistochemically negative for tau and transactive response (TAR) DNA-binding protein 43 (TDP-43), have been identified in patients with juvenile-onset amyotrophic lateral sclerosis (ALS) and adult-onset atypical ALS with ophthalmoplegia, autonomic dysfunction, cerebellar ataxia, or a frontal lobe syndrome. Mutations in the fused in sarcoma gene (FUS) have been reported in cases of familial and sporadic ALS, and FUS immunoreactivity has been demonstrated in basophilic inclusion body disease (BIBD), neuronal intermediate filament inclusion disease (NIFID), and atypical frontotemporal lobar degeneration with ubiquitin-positive and tau-negative inclusions (aFTLD-U). In the present study, we immunohistochemically and ultrastructurally studied an autopsy case of sporadic adult-onset ALS with numerous BIs. The patient presented with the classical clinical course of ALS since 75 years of age and died at age 79. Postmortem examination revealed that both Betz cells in the motor cortex and motor neurons in the spinal cord were affected. The substantia nigra was spared. Notably, BIs were frequently observed in the motor neurons of the anterior horns, the inferior olivary nuclei, and the basal nuclei of Meynert. BIs were immunopositive for p62, LC3, and FUS, but immunonegative for tau, TDP-43, and neurofilament. Ultrastructurally, BIs consisted of filamentous or granular structures associated with degenerated organelles with no limiting membrane. There were no Bunina bodies, skein-like inclusions, or Lewy-like inclusions. All exons and exon/intron boundaries of the FUS gene were sequenced but no mutations were identified. PMID:20573033

  13. Social Autopsy of maternal, neonatal deaths and stillbirths in rural Bangladesh: qualitative exploration of its effect and community acceptance

    PubMed Central

    Biswas, Animesh; Eriksson, Charli; Halim, Abdul; Dalal, Koustuv

    2016-01-01

    Objectives Social Autopsy (SA) is an innovative strategy where a trained facilitator leads community groups through a structured, standardised analysis of the physical, environmental, cultural and social factors contributing to a serious, non-fatal health event or death. The discussion stimulated by the formal process of SA determines the causes and suggests preventative measures that are appropriate and achievable in the community. Here we explored individual experiences of SA, including acceptance and participant learning, and its effect on rural communities in Bangladesh. The present study had explored the experiences gained while undertaking SA of maternal and neonatal deaths and stillbirths in rural Bangladesh. Design Qualitative assessment of documents, observations, focus group discussions, group discussions and in-depth interviews by content and thematic analyses. Results Each community's maternal and neonatal death was a unique, sad story. SA undertaken by government field-level health workers were well accepted by rural communities. SA had the capability to explore the social reasons behind the medical cause of the death without apportioning blame to any individual or group. SA was a useful instrument to raise awareness and encourage community responses to errors within the society that contributed to the death. People participating in SA showed commitment to future preventative measures and devised their own solutions for the future prevention of maternal and neonatal deaths. Conclusions SA highlights societal errors and promotes discussion around maternal or newborn death. SA is an effective means to deliver important preventative messages and to sensitise the community to death issues. Importantly, the community itself is enabled to devise future strategies to avert future maternal and neonatal deaths in Bangladesh. PMID:27554100

  14. Influence of ballistic and autopsy parameters on the manner of death in case of long firearms fatalities.

    PubMed

    de la Grandmaison, Geoffroy Lorin; Fermanian, Christophe; Aegerter, Philippe; Durigon, Michel

    2008-05-20

    A retrospective study was carried out on 132 fatalities due to gunshot wounds secondary to long firearms. One group of suicide (n=72) and one group of homicide (n=60) were statistically compared regarding age and sex of the victim, number of shots, range of fire, direction of the projectile(s), anatomical distribution of entrance sites, weapon and ammunition types and the nature of eventual associated traumatic lesions. The frequency of suicide was higher when the victim's age increased. Females constituted about 43% of the homicide victims and about 8% of the suicide victims. 51.5% of the homicide victims and about 10% of the suicide victims had sustained more than one gunshot wound. Close range was respectively found in 53.5% of the homicide cases and in all suicide cases. Most of the suicide cases (85% of the cases) showed typical entrance sites. Entrance sites in the limbs and lateral or posterior wall of the chest were only encountered in homicide cases. Associated traumatic lesions were found in about 23% of the homicide cases and in 18% of the suicide cases. In case of suicidal gunshots to the left chest, both upwards and downwards directions, and also both right-to-left and left-to-right directions can occur. From 22 suicide cases showing entrance wound in the mouth, a downwards direction was found in only one. This study underlines the importance but also the limits of the autopsy findings (including direction of the projectile(s) related to the entrance site) for giving an indication of the manner of death (homicide vs. suicide). PMID:18282673

  15. Whole Exome Sequencing of Rapid Autopsy Tumors and Xenograft Models Reveals Possible Driver Mutations Underlying Tumor Progression

    PubMed Central

    Xie, Tao; Musteanu, Monica; Lopez-Casas, Pedro P.; Shields, David J.; Olson, Peter; Rejto, Paul A.; Hidalgo, Manuel

    2015-01-01

    Pancreatic Ductal Adenocarcinoma (PDAC) is a highly lethal malignancy due to its propensity to invade and rapidly metastasize and remains very difficult to manage clinically. One major hindrance towards a better understanding of PDAC is the lack of molecular data sets and models representative of end stage disease. Moreover, it remains unclear how molecularly similar patient-derived xenograft (PDX) models are to the primary tumor from which they were derived. To identify potential molecular drivers in metastatic pancreatic cancer progression, we obtained matched primary tumor, metastases and normal (peripheral blood) samples under a rapid autopsy program and performed whole exome sequencing (WES) on tumor as well as normal samples. PDX models were also generated, sequenced and compared to tumors. Across the matched data sets generated for three patients, there were on average approximately 160 single-nucleotide mutations in each sample. The majority of mutations in each patient were shared among the primary and metastatic samples and, importantly, were largely retained in the xenograft models. Based on the mutation prevalence in the primary and metastatic sites, we proposed possible clonal evolution patterns marked by functional mutations affecting cancer genes such as KRAS, TP53 and SMAD4 that may play an important role in tumor initiation, progression and metastasis. These results add to our understanding of pancreatic tumor biology, and demonstrate that PDX models derived from advanced or end-stage likely closely approximate the genetics of the disease in the clinic and thus represent a biologically and clinically relevant pre-clinical platform that may enable the development of effective targeted therapies for PDAC. PMID:26555578

  16. Toxicologic and epidemiologic clues from the characterization of the 1952 London smog fine particulate matter in archival autopsy lung tissues.

    PubMed

    Hunt, Andrew; Abraham, Jerrold L; Judson, Bret; Berry, Colin L

    2003-07-01

    Exposure to atmospheric fine particulate matter (PM), even at low ambient concentrations, has clearly been linked to increases in mortality and morbidity. A 10- micro g m(-3) increase in PM10 (PM < 10 micro m) has been found to produce a 0.5% increase in daily mortality. The mechanism of action is a source of debate, although recent attention has focused on the cardiac effects of PM exposures. Likewise, several possible etiologic agents have been implicated, including ultrafine PM (PM autopsy tissues allow us the unique opportunity to report on the form and composition of December 1952 London PM in situ in tissues from persons known to have died from the smog exposure. Because absolute increases in mortality with current levels of PM in Western Europe and North America are low, analogous tissues are unlikely to be contemporaneously available. Taking a lung compartment (airway, airspace, interstitium, and lymph node) approach, we differentiated exposures contemporary with death from those of earlier origin. Electron microscopic analyses revealed the dominance of retained soot and a surfeit of other particle types. A variety of metal-bearing particle types were found in all compartments, but Pb, Zn, and SnZn types appeared the least biopersistent. The results support the acute toxicologic importance of ultrafine carbonaceous and metal PM. PMID:12842775

  17. [An autopsy case of neuronal type Charcot-Marie-Tooth disease (HMSN type II) with nerve deafness and psychiatric symptoms].

    PubMed

    Yoshimura, I; Yoshimura, N; Hanazono, T; Usutani, S; Muramoto, Y; Fukushima, Y

    1992-06-01

    The clinical and pathological findings of a 41-year-old male patient with atypical Charcot-Marie-Tooth disease were reported. There were 3 cases of subarachnoid haemorrhage, 2 nerve deafness and 2 hereditary motor and sensory neuropathy (HMSN) in his family. He had suffered from progressive nerve deafness since 5 years old and gait disturbance since 37 years old. He had been admitted to the psychiatric hospital 3 times because of hallucinatory-delusional state and behavior abnormalities. Neurological examinations at 39 years old revealed that he had mental deterioration (IQ 66), nerve deafness, diffuse muscle atrophy, most marked distally, sensory disturbance, areflexia, positive Romberg's sign, orthostatic hypotension, dysphagia and slurred speech. MCV of median nerve was 27.8 m/sec, and SCV was not evoked. EEG revealed nonspecific dysfunction of the brain. He died of ileus-like condition at 41 years old. General autopsy showed haemorrhagic infarction of the jejunum and ileum due to compression of the superior mesenteric artery and vein by an adhesion band of connective tissue formed after previous appendectomy. Neuropathological examinations revealed axonal degeneration and loss of myelinated fibers with schwannosis of anterior and posterior spinal nerve roots as well as peripheral nerves. The posterior roots were more severely affected than the anterior ones. Ganglion cells of the posterior root ganglia showed remarkable degeneration and loss. There was severe degeneration of the posterior columns, especially in the gracilis, of the spinal cord. Nerve cells in the anterior horns and Clarke's columns also displayed conspicuous atrophy or central chromatolysis followed by gliosis. There was slight degeneration of the posterior spinocerebellar tracts.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1389565

  18. Hemorrhagic small intestine cancer with solitary pulmonary metastasis initially presented as suspected primary lung cancer: an autopsy report.

    PubMed

    Iwata, Takashi; Inoue, Kiyotoshi; Kiriike, Sachiko; Izumi, Nobuhiro; Mizuguchi, Shinjiro; Tsukioka, Takuma; Morita, Ryuhei; Nishiyama, Noritoshi; Takemura, Masashi; Osugi, Harusi; Wakasa, Kenichi; Suehiro, Shigefumi

    2007-12-01

    Cancer of the small intestine presenting with a solitary pulmonary metastasis is rare. Diagnosis and treatment of hemorrhagic small intestinal disease is clinically problematic due to its anatomic aspect, especially after multiple laparotomies. The case that we present here was a 79-year-old man who was initially diagnosed with suspected T2N2M0 lung cancer. After non-diagnostic results on two bronchoscopic biopsies and computed tomography-guided needle biopsy, he was admitted for thoracoscopic biopsy and possible curative operation. The patient had a history of multiple laparotomies for gastric ulcer and had no abdominal symptoms. A fecal occult blood test was positive; this was thought to be because of persistent bloody sputum. During the preoperative evaluation period, massive intestinal hemorrhage occurred. Intestinal tumor was identified by double-balloon enteroscopy and emergency laparotomy was performed to control the bleeding. The histopathological diagnosis was metastatic adenocarcinoma. However, intestinal bleeding started again. His systemic status deteriorated progressively, resulting in death. Autopsy revealed a large polypoid tumor with hemorrhagic necrosis in the jejunum that was histologically and immunohistochemically diagnosed as primary poorly differentiated adenocarcinoma in the small intestine. Multiple small submucosal tumors with central ulceration were confirmed as intramural metastases. A lung mass in the right lower lobe was diagnosed as a metastatic lesion. In the diagnosis and treatment of the disease, we faced several clinically difficult problems. We here describe in detail the clinical course and the diagnostic and therapeutic difficulties of this rare case, with some references to the literature. PMID:18432067

  19. Elements in autopsy liver tissue samples from Greenlandic Inuit and Danes. V. Selenium measured by X-ray fluorescence spectrometry.

    PubMed

    Milman, Nils; Laursen, Jens; Byg, Keld-Erik; Pedersen, Henning Sloth; Mulvad, Gerd; Hansen, Jens Christian

    2004-01-01

    The content of selenium in normal liver tissue samples from Greenlandic Inuit was measured and the results compared with those obtained in normal liver tissue samples from Danes. Normal liver tissue samples were obtained at autopsy from 50 Greenlandic Inuit (27 men, 23 women) with a median age of 61 years (range 23-83) and from 74 Danes (44 men, 30 women) with a median age of 60 years (range 15-87). Total liver selenium content was measured by X-ray fluorescence spectrometry. The content of selenium (median) was in Inuit 26.6 micromol/kg dry liver (5-95 percentile: 15.2-49.4) and in Danes 17.7 micromol/kg dry liver (5-95 percentile: < 3.8-36.5) (p < 0.0001). Liver selenium content displayed no significant gender difference, either in Inuit or Danes. In Inuit men, there was a negative correlation between liver selenium content and age (rs = -0.39, p < 0.05), whereas Danish men displayed a positive correlation between liver selenium content and age (rs = 0.37, p = 0.02). There was no correlation in Inuit or Danish women. In Inuit, the median hepatic selenium index (liver selenium content divided by age) was 0.48 and in Danes 0.33 (p = 0.001). There was an inverse correlation between hepatic selenium index and age both in Inuit (rs = -0.77, p < 0.0001) and in Danes (rs = -0.47, p < 0.0001). In conclusion, Inuit had a higher liver content of selenium and a higher hepatic selenium index compared with Danes. The more favourable selenium status is due to a higher nutritional selenium intake with fish and meat from sea mammals. PMID:15139392

  20. Elements in autopsy liver tissue samples from Greenlandic Inuit and Danes. III. Zinc measured by X-ray fluorescence spectrometry.

    PubMed

    Laursen, J; Milman, N; Pedersen, H S; Mulvad, G; Saaby, H; Byg, K E

    2001-01-01

    The aim of the study was to measure the content of zinc (Zn) in liver tissue samples from Greenlandic Inuit using X-ray fluorescence spectrometry, and compare the results with those obtained in liver samples from Danes. Normal liver tissue samples was obtained at autopsy from 50 Greenlandic Inuit (27 men) with a median age of 61 years (range 23-83) and from 74 Danes (44 men) with a median age of 60 years (range 15-87). In the entire series, liver zinc content in Inuit was not significantly different compared with Danes. There was no significant gender difference in liver zinc content either in Inuit or in Danes. The content of zinc given as median (5-95 percentile) was in Inuit 3.809 mmol/kg dry liver (2.355-7.406), and in Danes 3.992 mmol/kg dry liver (2.499-8.645). There was a significant, positive correlation between liver zinc content and age in Danish women (r(s) = 0.43, p = 0.02), which could not be demonstrated in Danish men or in Inuit. Median hepatic zinc index (zinc content in mmol/kg dry weight divided by age in years) in Inuit was 0.073, and in Danes 0.080 (p = 0.3) without any significant difference between the two genders. In Inuit and Danes there was an inverse correlation between hepatic zinc index and age both in the two genders and in the entire series: Inuit: r(s) = -0.62, p < 0.0001; Danes: r(s) = -0.70, p < 0.0001. The results indicate that Inuit have liver zinc levels, which are similar to those found in Danes. PMID:11846009

  1. Immunohistochemistry of von Willebrand factor in the lungs with regard to the cause of death in forensic autopsy.

    PubMed

    Quan, Li; Ishikawa, Takaki; Zhao, Dong; Michiue, Tomomi; Yoshida, Chiemi; Chen, Jian-hua; Wang, Qi; Zhu, Bao-Li; Maeda, Hitoshi

    2009-04-01

    Pulmonary microvascular injury is involved in severe trauma or disease. The present study investigated the immunohistochemical distribution of von Willebrand factor (vWF) and platelet CD61 factor in forensic autopsy cases (n=157, >18 years of age, within 48 h postmortem), which comprised fatalities from blunt and sharp instrument injuries, strangulation, fire fatality and acute cardiac death (ACD). vWF immunoreactivity was clearly detected in the endothelia of large vessels (LV, phi>200 microm), small vessels (SV, phi 40-200 microm) and capillaries (Cap, phi<40 microm). Cap-vWF positivity was also detected in microthrombi with CD61 immunopositivity. The vWF positivity was higher in non-edema areas than in the edema area in the lungs. For acute deaths, Cap-vWF positivity of non-edema areas was frequently detected for strangulation (n=8/13, 61.5%), fire fatality (n=11/26, 42.3%) and ACD (n=8/15, 53.3%), but was infrequent for blunt and sharp instrument injuries (n=6/27, 22.5%, and n=2/15, 13.3%, respectively), irrespective of the complication of chest injury. However, for non-acute deaths, Cap-vWF positivity was more frequent for non-chest blunt injury (n=12/27, 44.4%) than for blunt chest injury (n=3/13, 23.1%) and sharp instrument injury (n=0/10, 0%). For fire fatality, Cap-vWF positivity was relatively frequent in cases with a lower blood carboxyhemoglobin (COHb) level of <60% (n=6/14, 42.8%) than in cases with a higher COHb level of >60% (n=3/12, 25.0%). These findings suggest that Cap-vWF positivity is closely related to the death process involving pulmonary microvascular injury. PMID:19261528

  2. Evaluation of postmortem serum calcium and magnesium levels in relation to the causes of death in forensic autopsy.

    PubMed

    Zhu, Bao-Li; Ishikawa, Takaki; Quan, Li; Li, Dong-Ri; Zhao, Dong; Michiue, Tomomi; Maeda, Hitoshi

    2005-12-01

    There appears to be very poor investigation of postmortem serum calcium (Ca) and magnesium (Mg) for diagnostic evidence to determine the cause of death. The aim of the present study was a comprehensive analysis of the serum levels in relation to the causes of death in routine casework. Autopsy cases (total, n=360; 5-48 h postmortem), including blunt injury (n=76), sharp injury (n=29), asphyxiation (n=42), drownings (n=28: freshwater, n=11; saltwater, n=17), fire fatalities (n=79), methamphetamine (MA) poisoning (n=8), delayed death from traumas (n=37), and acute myocardial infarction/ischemia (AMI, n=61), were examined. In total cases, there was no significant postmortem time-dependent rise in serum Ca and Mg. Both Ca and Mg levels in the heart and peripheral blood were significantly higher in saltwater drowning compared with those of the other groups. In addition, a significant elevation in the Ca level was observed in freshwater drowning and fire fatalities, and in the Mg level in fatal MA intoxication and asphyxiation. Topographic analyses suggested a rise in serum Ca and Mg due to aspirated saltwater in drowning, that in serum Ca in freshwater drowning and fire fatalities of peripheral skeletal muscle origin and that in serum Mg in MA fatality and asphyxiation of myocardial and/or peripheral origin. These markers may be useful especially for diagnosis and differentiation of salt- and freshwater drownings and may be also helpful to determine the causes of death involving skeletal muscle damage, including burns and MA intoxication. PMID:16216707

  3. Toxicologic and epidemiologic clues from the characterization of the 1952 London smog fine particulate matter in archival autopsy lung tissues.

    PubMed Central

    Hunt, Andrew; Abraham, Jerrold L; Judson, Bret; Berry, Colin L

    2003-01-01

    Exposure to atmospheric fine particulate matter (PM), even at low ambient concentrations, has clearly been linked to increases in mortality and morbidity. A 10- micro g m(-3) increase in PM10 (PM < 10 micro m) has been found to produce a 0.5% increase in daily mortality. The mechanism of action is a source of debate, although recent attention has focused on the cardiac effects of PM exposures. Likewise, several possible etiologic agents have been implicated, including ultrafine PM (PM autopsy tissues allow us the unique opportunity to report on the form and composition of December 1952 London PM in situ in tissues from persons known to have died from the smog exposure. Because absolute increases in mortality with current levels of PM in Western Europe and North America are low, analogous tissues are unlikely to be contemporaneously available. Taking a lung compartment (airway, airspace, interstitium, and lymph node) approach, we differentiated exposures contemporary with death from those of earlier origin. Electron microscopic analyses revealed the dominance of retained soot and a surfeit of other particle types. A variety of metal-bearing particle types were found in all compartments, but Pb, Zn, and SnZn types appeared the least biopersistent. The results support the acute toxicologic importance of ultrafine carbonaceous and metal PM. PMID:12842775

  4. Distribution and components of interstitial inflammation and fibrosis in IgG4-related kidney disease: analysis of autopsy specimens.

    PubMed

    Hara, Satoshi; Kawano, Mitsuhiro; Mizushima, Ichiro; Harada, Kenichi; Takata, Takuma; Saeki, Takako; Ubara, Yoshifumi; Sato, Yasuharu; Nagata, Michio

    2016-09-01

    IgG4-related kidney disease (IgG4-RKD) occasionally progresses to chronic renal failure and is pathologically characterized by IgG4-positive lymphoplasmacyte-rich tubulointerstitial nephritis with storiform fibrosis (bird's-eye pattern fibrosis). Although radiology reveals a heterogeneous distribution of affected areas in this disease, their true distribution within the whole kidney is still unknown because of difficulty in estimating this from needle biopsy samples. Using 5 autopsy specimens, the present study histologically characterized the distribution and components of interstitial inflammation and fibrosis in IgG4-RKD. Interstitial lymphoplasmacytic infiltration or fibrosis was observed in a variety of anatomical locations such as intracapsular, subcapsular, cortical, perivascular, and perineural regions heterogeneously in a patchy distribution. They tended to be more markedly accumulated around medium- and small-sized vessels. Storiform fibrosis was limited to the cortex. Immunostaining revealed nonfibrillar collagens (collagen IV and VI) and fibronectin predominance in the cortical lesion, including storiform fibrosis. In contrast, fibril-forming collagens (collagen I and III), collagen VI, and fibronectin were the main components in the perivascular lesion. In addition, α-smooth muscle actin-positive myofibroblasts were prominently accumulated in the early lesion and decreased with progression, suggesting that myofibroblasts produce extracellular matrices forming a peculiar fibrosis. In conclusion, perivascular inflammation or fibrosis of medium- and small-sized vessels is a newly identified pathologic feature of IgG4-RKD. Because storiform fibrosis contains mainly nonfibrillar collagens, "interstitial fibrosclerosis" would be a suitable term to reflect this. The relation between the location and components of fibrosis determined in whole kidney samples provides new clues to the pathophysiology underlying IgG4-RKD. PMID:27246178

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

    SciTech Connect

    Kayaalti, Zeliha; Mergen, Goerkem; Soeylemezoglu, Tuelin

    2010-06-01

    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 {mu}g/g, 181.20 {+-} 87.72 {mu}g/g and 17.14 {+-} 16.28 {mu}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 {mu}g/g) and GG genotypes (153.09 {mu}g/g) compared with individuals having AA genotype (87.72 {+-} 62.98 {mu}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.

  6. Atherosclerosis in coronary artery and aorta in a semi-urban population by applying modified American Heart Association classification of atherosclerosis: An autopsy study

    PubMed Central

    Thej, Mothakapalli Jagadish; Kalyani, Raju; Kiran, Jayaramaiah

    2012-01-01

    Background: Ischemic heart disease (IHD) following atherosclerosis is a giant killer and the incidence of atherosclerosis in coronary arteries is rapidly increasing among Indians. The study was formulated to assess the histomorphological atherosclerotic changes in aorta and coronary arteries at autopsy by applying the modified American Heart Association classification of atherosclerosis based on morphological descriptions to find out the age and sex related prevalence of atherosclerosis in the semi-urban population of Kolar, a district in Southern India. Materials and Methods: Autopsy was conducted on 113 cases whose age ranged from 8-85 years. Autopsy was conducted by the conventional technique; heart and the aorta were removed and fixed in 10% formalin. The heart was dissected along the direction of flow of blood and aorta along the posterior surface. Microscopic assessment of the three main coronary arteries and aorta was done using the modified American Heart Association classification of atherosclerosis. Proportions were analyzed using Chi-square test. Results: The number of males was 78 (69%) and number of females was 35 (31%). Mean age was 37.11 ± 15.69 years. Increased incidence of intermediate lesions was noted in young individuals (15-34 yrs). Atherosclerotic lesions were more in left anterior descending artery compared to other coronary arteries and in abdominal aorta compared to thoracic and ascending aorta. Vulnerable plaques were more in right coronary artery. Conclusion: With cardiovascular disease attaining pandemic proportions, the study of subclinical atherosclerosis is the need of the hour to estimate the disease burden in the asymptomatic population. The increased amount of atherosclerosis (advanced and intermediate lesions) found in the young population in this study gives an indication that anti-atherogenic preventive measures need to be implemented in young individuals, so as to prevent coronary artery disease from causing premature death

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

    PubMed Central

    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

  8. Association of the apolipoprotein E {epsilon}4 allele with clinical subtypes of autopsy-confirmed Alzheimer`s Disease

    SciTech Connect

    Zubenko, G.S.; Stiffler, S.; Kopp, U.

    1994-09-15

    Consistent with previous reports, we observed a significant association of the APOE {epsilon}4 allele with Alzheimer`s Disease (AD) in a series of 91 autopsy-confirmed cases. The {epsilon}4 allele frequency was higher in cases with a family history of AD-like dementia (0.54 {+-} 0.07), although the {epsilon}4 allele frequency in the AD cases with a negative family history (0.38 {+-} 0.05) remained significantly greater than that for the non-AD control group (0.13 {+-} 0.03). A similar increase in {epsilon}4 allele frequency (0.54 {+-} 0.07) was observed in the AD cases with amyloid angiopathy, compared to those who did not have amyloid angiopathy (0.35 {+-} 0.04). Contrary to previous reports, no effect of the dosage of the {epsilon}4 allele was found on the age of onset of dementia among the AD cases and, contrary to reports suggesting an association of {epsilon}4 and atherosclerosis, the {epsilon}4 allele frequency was similar in cases with or without concurrent brain infarcts. Modest but consistent correlations were observed between the dosage of {epsilon}4 alleles and the cortical density of senile plaques, but not neurofibrillary tangles. The last finding suggests that the pathogenic events mediated by the {epsilon}4 allele may be more directly involved in the formation of senile plaques, the identifying lesions in AD, than neurofibrillary tangles. A robust association of both the presence of an {epsilon}4 allele and a family history of AD-like dementia with concurrent amyloid angiopathy occurred within our sample of AD cases. This association arose from an interaction of the {epsilon}4 allele with a separate familial factor for which a family history of dementia served as a surrogate. These results suggest that amyloid angiopathy may be a common or central feature of a form of familial AD that is associated with the transmission of the APOE {epsilon}4 allele. 22 refs., 2 figs., 5 tabs.

  9. Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death

    PubMed Central

    Hussain-Alkhateeb, Laith; Fottrell, Edward; Petzold, Max; Kahn, Kathleen; Byass, Peter

    2015-01-01

    Background Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Method Using 20 years of VA data (n=11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Results Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15–49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Conclusion Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community

  10. Public Education: An Autopsy.

    ERIC Educational Resources Information Center

    Lieberman, Myron

    This book argues that public education no longer fosters in students basic skills, scientific and cultural literacy, civic virtues, and desirable habits/attitudes toward society and its institutions. The book asserts that government provision of goods and services is usually less effective and efficient than provision through a market system. It…

  11. Death by 'ice': fatal methamphetamine intoxication of a body packer case detected by postmortem computed tomography (PMCT) and validated by autopsy.

    PubMed

    Bin Abdul Rashid, Saiful Nizam; Rahim, Amir Saad Abdul; Thali, Michael J; Flach, Patricia M

    2013-03-01

    Fatal acute methamphetamine (MA) poisoning in cases of internal drug trafficking is rarely described in the literature. This case study reports an MA 'body packer' who died from fatal methamphetamine intoxication due to leaking drug packages in the alimentary tract. The deceased was examined by postmortem computed tomography (PMCT), and the results were correlated to subsequent autopsy and toxicological findings. The deceased was arrested by the police when he was found disoriented in the city of Kuala Lumpur. He was transferred to the emergency department on suspicion of drug abuse. The initial drug screening was reactive for amphetamines. Shortly after admission to the hospital, he died despite rigorous resuscitation attempts. The postmortem plain chest and abdominal radiographs revealed multiple suspicious opacities in the gastrointestinal tract attributable to body packages. An unenhanced whole body PMCT revealed twenty-five drug packages, twenty-four in the stomach and one in the transverse colon. At least two were disintegrating, and therefore leaking. The autopsy findings were consistent with the PMCT results. Toxicology confirmed the diagnosis of fatal methamphetamine intoxication. PMID:23404531

  12. Genotyping of Toxoplasma gondii: DNA extraction from formalin-fixed paraffin-embedded autopsy tissues from AIDS patients who died by severe disseminated toxoplasmosis.

    PubMed

    Bastos da Silva, Inara; Batista, Tatiana Pimental de Andrade; Martines, Roosecelis Brasil; Kanamura, Cristina Takami; Ferreira, Isabelle Martins Ribeiro; Vidal, Jose Ernesto; Pereira-Chioccola, Vera Lucia

    2016-06-01

    This study investigated the genetic features of Toxoplasma gondii isolated directly in autopsies of HIV-infected patients who died with severe disseminated toxoplasmosis. This retrospective analysis was conducted in a cohort of 15 HIV-infected patients with clinical and laboratory data. They had previous cerebral toxoplasmosis at least 6 months before the disseminated toxoplasmosis episode. The hypothesis was that they were infected with highly virulent parasites due to the condition in which they died. T. gondii genotyping was done directly in DNA extracted from 30 autopsy brain and lung samples (2 per patient) and mutilocus PCR-RFLP genotyping was done using 12 molecular markers. The 30 clinical samples were genotyped successfully in 8 or more loci and six suggestive genotypes were identified. One of them was Toxo DB #11, previously identified in different domestic animals and virulent in experimental animals. The other five suggestive genotypes identified in 14 patients were not described. TgHuDis1 was the most frequent and was determined in 8 patients. TgHuDis3 and TgHuDis5 were identified in two patients each. TgHuDis2 and TgHuDis4 have been identified in one patient each. These suggestive genotypes could be considered as virulent, since they caused severe tissue damage and had similar characteristics as Toxo # DB 11. PMID:26969767

  13. Familial motor neuron disease with prominent onion-bulb-like structures and axonal swelling restricted to the spinal ventral root: autopsy findings in two siblings.

    PubMed

    Tokuyama, Wataru; Yagishita, Saburo; Ryo, Masafuchi; Kusunoki, Junichi; Hasegawa, Kazuko; Yoshida, Tsutomu; Mikami, Tetuo; Okayasu, Isao

    2010-02-01

    We report autopsy cases of two siblings who developed muscular atrophy and dementia, clinically considered to be familial motor neuron disease (MND). They presented with motor neuron signs predominantly in the distal limbs without sensory impairment. At autopsy, severe neuronal loss in the anterior horn consistent with MND was found, but histopathological hallmarks like Bunina bodies and skein-like inclusions were absent. Surprisingly, numerous huge axonal swellings (about 30 microm in diameter) and onion-bulb-like structures were found in the spinal ventral roots. These changes were not observed in spinal dorsal roots or peripheral nerves. However, obvious segmental demyelination of the ventral root was not found. In addition, neurofibrillary tangles (NFTs) and neuritic plaques were present in the frontal cortex, temporal cortex and hippocampus, and to a lesser degree, in the amygdala, substantia nigra and thalamus. Our two cases are a hitherto unreported type of MND, which shows focal giant axonopathy and prominent formation of onion-bulb-like structures due to Schwann cell proliferation restricted to the spinal ventral roots. PMID:19496941

  14. Unusual Presentation of Anaplastic Large Cell Lymphoma with Clinical Course Mimicking Fever of Unknown Origin and Sepsis: Autopsy Study of Five Cases

    PubMed Central

    Mosunjac, Marina B.; Sundstrom, J. Bruce; Mosunjac, Mario I.

    2008-01-01

    Aim To describe a subset of cases with the unusual clinical and histomorphological presentation of anaplastic large cell lymphoma (ALCL) mimicking fever of unknown origin (FUO) and sepsis. Methods A pathology database was searched using full term Systematized Nomenclature of Medicine codes for ALCL to identify 23ALCL cases from the period 1999-2006. Of those, five cases that did not have a correct premortem diagnosis were further analyzed to elucidate the reasons for delayed and incorrect pre-mortem diagnosis. The analyzed data included clinical presentation, duration of symptoms, duration of hospital stay, premortem presumed cause of death, white blood cell count, platelet count, anion gap and blood pH, liver enzymes (alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase), lactate, coagulation tests (prothrombin time, partial thromboplastin time, fibrinogen, D-dimers), microbiology cultures, and radiology and surgical pathology reports. Autopsy reports were reviewed for description of major gross findings, initial clinical diagnosis, and cause of death. Results Five fatal and pre-mortem unrecognized ALCL cases were characterized by rapid decline, with histologic findings showing predominantly extranodal involvement, intravascular lymphomatosis, and hemophagocytosis. The cases were also characterized by unusual clinical manifestations including a FUO, sepsis, and disseminated intravascular coagulation-like picture, lactic acidosis, hepatosplenomegaly, and absence of significant peripheral adenopathy. Conclusions There is a distinct group of ALCLs with unique and specific clinical, gross autopsy, and histopathologic findings. Recognition of this clinical variant may facilitate early detection and potentially timely diagnosis and therapy. PMID:18925700

  15. [Corpse disposal by concealment in transport containers or packaging materials: Examination by post-mortem computed tomography (PMCT) before forensic autopsy].

    PubMed

    Hasegawa, Iwao; Heinemann, Axel; Jahnke, Philipp; Wilke, Nadine; Kammal, Michael; Püschel, Klaus

    2014-01-01

    The presented case reports illustrate the value of post-mortem computed tomography in cases of homicide in which the body was hidden in a container or packaging material and could not be inspected directly from outside. In Case 1, the body was forced into a suitcase, which was then thrown into a flood basin. Post-mortem computed tomography (PMCT) visualized the compressed and extremely flexed body inside the suitcase as well as fractures of the left temporal bone, the left ulna and the left side of the mandible. After recovery of the body, the consequences of long-term immersion in fresh water became visible. At autopsy, a laceration in the left temporal region and a temporal bone fracture were observed. The fractures of the left ulna and the left jaw were associated with moderate hematoma. In Case 2, the body of an 11-year-old girl was retrieved from a plastic bag concealed in a garden shed. The cause of death was ligature strangulation. In the presented cases, PMCT was performed as part of the police investigations for reliable primary documentation of the contents of the containers without further manipulation. Thus the human body, its position inside the container and the presence of bone injuries could be demonstrated before opening the container. In such cases, post-mortem imaging provides reliable and rapid information to the investigating authorities before autopsy already. PMID:26548018

  16. Beta-d-Glucan Detection as a Diagnostic Test for Invasive Aspergillosis in Immunocompromised Critically Ill Patients with Symptoms of Respiratory Infection: an Autopsy-Based Study ▿

    PubMed Central

    De Vlieger, Greet; Lagrou, Katrien; Maertens, Johan; Verbeken, Eric; Meersseman, Wouter; Van Wijngaerden, Eric

    2011-01-01

    Beta-(1,3)-d-glucan (BG) detection is an emerging tool to diagnose invasive fungal infections (IFIs). Invasive aspergillosis (IA) is the second most common IFI in immunocompromised intensive care unit (ICU) patients. We retrospectively analyzed the serum BG concentration (Fungitell; Associates of Cape Cod) in immunocompromised ICU patients with proven IA and in immunocompromised ICU patients in whom autopsy failed to show IFI. The study was performed in a 17-bed medical ICU in a 1,900-bed referral hospital. Patients at risk for IA were eligible for inclusion when at least two additional clinical signs were present. Patients with other IFIs were excluded. Fourteen patients with IA and 33 patients who had no IFI were eligible for inclusion. Serum BG levels were significantly higher in patients with IA than patients without an IFI (P < 0.01). Using a cutoff of 140 pg/ml, the sensitivity and specificity were 85.7 and 69.7%, respectively; the positive and negative predictive values were 54.5 and 92.0%, respectively. The positive and negative likelihood ratios were 2.83 and 0.21, respectively. Although serum BG concentrations were higher in immunocompromised ICU patients with IA than in patients with the same risk factors who did not have IFI on autopsy, the moderate performance characteristics of this test limit its use as a diagnostic test for IA in this population. PMID:21880959

  17. Beta-D-glucan detection as a diagnostic test for invasive aspergillosis in immunocompromised critically ill patients with symptoms of respiratory infection: an autopsy-based study.

    PubMed

    De Vlieger, Greet; Lagrou, Katrien; Maertens, Johan; Verbeken, Eric; Meersseman, Wouter; Van Wijngaerden, Eric

    2011-11-01

    Beta-(1,3)-D-glucan (BG) detection is an emerging tool to diagnose invasive fungal infections (IFIs). Invasive aspergillosis (IA) is the second most common IFI in immunocompromised intensive care unit (ICU) patients. We retrospectively analyzed the serum BG concentration (Fungitell; Associates of Cape Cod) in immunocompromised ICU patients with proven IA and in immunocompromised ICU patients in whom autopsy failed to show IFI. The study was performed in a 17-bed medical ICU in a 1,900-bed referral hospital. Patients at risk for IA were eligible for inclusion when at least two additional clinical signs were present. Patients with other IFIs were excluded. Fourteen patients with IA and 33 patients who had no IFI were eligible for inclusion. Serum BG levels were significantly higher in patients with IA than patients without an IFI (P < 0.01). Using a cutoff of 140 pg/ml, the sensitivity and specificity were 85.7 and 69.7%, respectively; the positive and negative predictive values were 54.5 and 92.0%, respectively. The positive and negative likelihood ratios were 2.83 and 0.21, respectively. Although serum BG concentrations were higher in immunocompromised ICU patients with IA than in patients with the same risk factors who did not have IFI on autopsy, the moderate performance characteristics of this test limit its use as a diagnostic test for IA in this population. PMID:21880959

  18. Role of transparent exopolymer particles on membrane fouling in a full-scale ultrafiltration plant: feed parameter analysis and membrane autopsy.

    PubMed

    Discart, V; Bilad, M R; Van Nevel, S; Boon, N; Cromphout, J; Vankelecom, I F J

    2014-12-01

    Ultrafiltration (UF) is widely used for water purification, but membrane fouling remains an important issue. In this study, the role of transparent exopolymer particles (TEPs), recently put forward as possible major foulants, was investigated in the fouling process of a full-scale UF installation. Algae, TEPs and other parameters in the UF feed were monitored and correlated during an 8 months long full-scale operation. Results revealed a complex fouling mechanism involving interactions mainly between algae, Fe (flocculant) and TEPs. Algae related parameters rather that TEP concentrations correlated stronger with irreversible fouling rates, suggesting that the overall role of TEPs in membrane fouling seems limited for this application. Finally, membrane autopsy showed the formation of a thick Fe-rich fouling layer on top of the fouled membranes, which could mostly be removed via cleaning-in-place. It remained partly irremovable in the form of some Fe-organic complexes. PMID:25285761

  19. Vanadium in ambient air: concentrations in lung tissue from autopsies of Mexico City residents in the 1960s and 1990s.

    PubMed

    Fortoul, Teresa Imelda; Quan-Torres, Alma; Sánchez, Ivonne; López, Irma Elena; Bizarro, Patricia; Mendoza, Maria Luisa; Osorio, Liliana Saldivar; Espejel-Maya, Guadalupe; Avila-Casado, Maria del Carmen; Avila-Costa, Maria Rosa; Colin-Barenque, Laura; Villanueva, Daniel Navarro; Olaiz-Fernandez, Gustavo

    2002-01-01

    Vanadium concentrations in lung tissue were determined by atomic absorption spectrometry from autopsy specimens taken from residents of Mexico City during the 1960s and 1990s (20 males and 19 females, and 30 males and 18 females, respectively). Samples from the 1990s had significantly increased mean vanadium concentrations (mean +/- standard deviation: 1.36 +/- 0.08), compared with those from the 1960s (1.04 +/- 0.05). Concentrations were not correlated with gender, smoking habit, age, cause of death, or occupation. These findings suggest that vanadium in ambient air is increasing and it represents a potential health hazard for Mexico City residents. Air pollution monitoring efforts should include vanadium concentrations in suspended particles to follow-up the findings reported herein. Researchers need to acquire a better knowledge of the levels of airborne vanadium exposure at which risk to human health occurs. PMID:12641188

  20. Role of Cardiac Myocytes Heart Fatty Acid Binding Protein Depletion (H-FABP) in Early Myocardial Infarction in Human Heart (Autopsy Study)

    PubMed Central

    Shabaiek, Amany; Ismael, Nour El-Hoda; Elsheikh, Samar; Amin, Hebat Allah

    2016-01-01

    BACKGROUND: Many immunohistochemical markers have been used in the postmortem detection of early myocardial infarction. AIM: In the present study we examined the role of Heart-type fatty acid binding protein (H-FABP), in the detection of early myocardial infarction. MATERIAL AND METHODS: We obtained samples from 40 human autopsy hearts with/without histopathological signs of ischemia. RESULTS: All cases of definite and probable myocardial infarction showed a well-defined area of H-FABP depletion. All of the control cases showed strong H-FABP expression, except two markedly autolysed myocardial samples that showed affected antigenicity. CONCLUSION: Thus, we suggest H-FABP as being one of the valuable tools facing the problem of postmortem detection of early myocardial infarction/ischemia, but not in autolysis.

  1. [Postmortem dismemberment/mutilation--medicolegal and criminalistic evaluation of the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School].

    PubMed

    Schulz, Yvonne; Mossakowski, Harald; Albrecht, Knut; Breitmeier, Dirk

    2008-01-01

    Among all the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School between 1978 and 1998. 16 cases of postmortem dismemberment/mutilation were evaluable under criminalistic and medicolegal aspects. In the present study, particular attention was paid to the psychosocial circumstances of the perpetrator's and victim's lives and also to the classification of the different types of postmortem dismemberment/mutilation illustrated by case reports. Apart from an unfavourable personal life situation at the time of the offence, essential predisposing factors were: poor integration in society and family, occupational problems, drug abuse and mental diseases. As the interactions between these factors differ in every single case and may be combined with other factors, the analysis of such homicides should always be based on the assessment of the individual case. PMID:18389859

  2. Metals in lung tissue from autopsy cases in Mexico City residents: comparison of cases from the 1950s and the 1980s.

    PubMed Central

    Fortoul, T I; Osorio, L S; Tovar, A T; Salazar, D; Castilla, M E; Olaiz-Fernández, G

    1996-01-01

    In autopsies performed on residents of Mexico City during the 1950s and 1980s (45 males and 24 females and 42 males and 42 females, respectively), concentrations of cadmium, copper, cobalt, nickel, and lead in the lungs were studied by atomic absorption spectrometry. Sharp increases were noted in samples taken in the 1980s compared to those from the 1950s. In samples from both time periods, the concentrations were influenced by gender. Smoking was not associated with higher levels of the metals. Only lead seemed to have a relation with age. The enormous differences by gender in the 1950s could be due to different patterns of exposure. The differences among samples from both periods appear to be associated with the increase of air pollutants in the metropolitan areas of Mexico City during the years under study. These results reinforce the importance of studying lung tissue to monitor air pollution by metals. PMID:8793351

  3. Cadmium in kidney cortex, liver, and pancreas from Swedish autopsies. Estimation of biological half time in kidney cortex, considering calorie intake and smoking habits.

    PubMed

    Elinder, C G; Lind, B; Kjellström, T; Linnman, L; Friberg, L

    1976-01-01

    Cadmium and zinc have been analyzed in tissues from 292 persons autopsied in Stockholm. In kidney cortex, liver, and pancreas the individual cadmium levels are distributed in a lognormal way. In kidney cortex there is a continuous accumulation of cadmium with age up to 50 years, followed by a decrease. Smokers show a higher cadmium accumulation. For nonsmokers, the biological half time of cadmium in kidney cortex is estimated at 30 years, with an average concentration at age 50 of 11 mug/g wet weight. When smokers are included, the average cadmium concentration at age 50 is 22 mug/g wet weight. Based on the more pronounced cadmium accumulation among smokers than nonsmokers, the respiratory absorption rate of cadmium from tobacco smoke is estimated to be approximately 50%. PMID:999342

  4. Cardiac biomarkers in blood, and pericardial and cerebrospinal fluids of forensic autopsy cases: A reassessment with special regard to postmortem interval.

    PubMed

    Chen, Jian-Hua; Inamori-Kawamoto, Osamu; Michiue, Tomomi; Ikeda, Sayuko; Ishikawa, Takaki; Maeda, Hitoshi

    2015-09-01

    Previous studies suggested possible application of postmortem biochemistry of myocardial biomarkers to the investigation of sudden cardiac death; however, differences from clinical findings should be considered in autopsy materials. The present study involved a comprehensive investigation of cardiac troponin T and I (cTnT and cTnI), and creatine kinase MB (CK-MB) in cardiac and peripheral external iliac venous blood, pericardial fluid (PCF) and cerebrospinal fluid (CSF) for reassessment, with special regard to the estimated postmortem interval in relation to the cause of death, reviewing a large number of forensic autopsy cases (n=1923). These cardiac biomarkers showed cause-of-death- and postmortem-time-dependent differences: blood and PCF levels of each marker were higher in hyperthermia (heatstroke), bathwater drowning and chronic congestive heart disease in cases of postmortem interval (PMI) <12h. After 12h postmortem, these markers were also higher in fatal drug abuse, spontaneous cerebral/subarachnoid bleeding, electrocution and pulmonary embolism. In addition, most other causes of death, including ischemic heart disease, showed substantial elevations, while these markers remained low in acute hemorrhagic death from sharp instrument injury, hypothermia (cold exposure) and sea-/freshwater drowning during PMI of <48h. CSF cTnI and CK-MB showed similar findings. There was no difference between myocardial infarction and other causes of death to be discriminated, including asphyxiation, drowning and fire fatality. These findings are similar to clinical observations in critical ill patients, suggesting that elevated cardiac biomarkers cannot be a specific finding for death from acute ischemic heart disease, but indicate the severity of myocardial injury in postmortem investigation. PMID:26052007

  5. Post-Mortem Whole Exome Sequencing with Gene-Specific Analysis for Autopsy Negative Sudden Unexplained Death in the Young: A Case Series

    PubMed Central

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

    2016-01-01

    Background 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 4 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. Materials and Methods 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. Results On average, each SUDY case had 12,758 ± 2016 non-synonymous variants, of which 79 ± 15 localized to these 117 genes. Overall, 8 ultra-rare variants (7 missense, 1 in-frame insertion) absent in 3 publically available exome databases were identified in 6 genes (3 in TTN, and 1 each in CACNA1C, JPH2, MYH7, VCL, RYR2) in 7 of 14 cases (50%). Of the 7 missense alterations, 2 (T171M-CACNA1C, I22160T-TTN) were predicted damaging by 3 independent in-silico tools. Conclusions 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 less families be informed prematurely and incorrectly that the root cause has been found. PMID:25500949

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

    PubMed

    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

  7. Forensic diagnosis and classification of snakebite (neurotoxic and haemotoxic) from renal changes at autopsy: morphological and histological determinants using a semi-quantitative method.

    PubMed

    Mukhopadhyay, Partha Pratim; Ghosh, Sulekha; Ghosh, Kumar Tapan

    2010-07-01

    Mortality due to poisonous snakebite is an emerging public health concern. Of late, snakebite has drawn global attention. Snakebite is a well-known cause of renal pathology especially in the haemotoxic group. Deaths due to renal failure are very common in envenomation due to poisonous snakebite. In this investigation our aim was to devise autopsy-proven diagnostic criteria of snakebite from the renal changes to confirm and classify the type of snakebite in forensic casework. That would be of practical help to the forensic pathologist with access to limited resources. An arbitrary scoring system from histology was adopted for the present semi-quantitative analysis. The scoring system (with scores from 0 to 5) developed by the present study was effective, valid and was able to distinguish between snakebite and control. The score obtained at histology in cases of snakebite was significantly different from the control group (Mann-Whitney U = 71.5; P = 0.011). Using stepwise linear discriminant function (DF) analysis, the score (Mukhopadhyay's score [MS]) was seen to be the only predictor of the type of snakebite. This model (DF = 1.05 x MS-1.78) could correctly classify 93.3% of the cases into neurotoxic and haemotoxic variety of offending snake. This is an effective, cheap and easy semi-quantitative method of distinguishing neurotoxic and haematoxic snakes from the renal changes at autopsy. It would be useful for practical application in centres where sophisticated biochemical or immunological analyses are not available due to limited resources. PMID:21133265

  8. Causes of Death and Autopsy Findings in a Large Study Cohort of Individuals with Cornelia de Lange Syndrome and Review of the Literature

    PubMed Central

    Schrier, Samantha A.; Sherer, Ilana; Deardorff, Matthew A.; Clark, Dinah; Audette, Lynn; Gillis, Lynette; Kline, Antonie D.; Ernst, Linda; Loomes, Kathy; Krantz, Ian D.; Jackson, Laird G.

    2011-01-01

    To identify causes of death (COD) in propositi with Cornelia de Lange syndrome (CdLS) at various ages, and to develop guidelines to improve management and avoid morbidity and mortality, we retrospectively reviewed a total of 426 propositi with confirmed clinical diagnoses of CdLS in our database who died in a 41-year period between 1966–2007. Of these, 295 had an identifiable COD reported to us. Clinical, laboratory and complete autopsy data were completed on 41, of which 38 were obtainable, an additional 19 had autopsies that only documented the COD, and 45 propositi had surgical, imaging, or terminal event clinical documentation of their COD. Proband ages ranged from fetuses (21 to 40 weeks gestation) to 61 years. A literature review was undertaken to identify all reported causes of death in CdLS individuals. In our cohort of 295 propositi with a known COD, respiratory causes including aspiration/reflux and pneumonias were the most common primary causes (31%), followed by gastrointestinal disease, including obstruction/volvulus (19%). Congenital anomalies accounted for 15% of deaths and included congenital diaphragmatic hernia and congenital heart defects. Acquired cardiac disease accounted for 3% of deaths. Neurological causes and accidents each accounted for 8%, sepsis for 4%, cancer for 2%, renal disease for 1.7%, and other causes, 9% of deaths. We also present 21 representative clinical cases for illustration. This comprehensive review has identified important etiologies contributing to the morbidity and mortality in this population that will provide for an improved understanding of clinical complications, and management for children and adults with CdLS. PMID:22069164

  9. Factors associated with delay in care–seeking for fatal neonatal illness in the Sylhet district of Bangladesh: results from a verbal and social autopsy study

    PubMed Central

    Nonyane, Bareng AS; Kazmi, Narjis; Koffi, Alain K; Begum, Nazma; Ahmed, Salahuddin; Baqui, Abdullah H; Kalter, Henry D

    2016-01-01

    Background We conducted a social and verbal autopsy study to determine cultural–, social– and health system–related factors that were associated with the delay in formal care seeking in Sylhet district, Bangladesh. Methods Verbal and social autopsy interviews were conducted with mothers who experienced a neonatal death between October 2007 and May 2011. We fitted a semi–parametric regression model of the cumulative incidence of seeking formal care first, accounting for competing events of death or seeking informal care first. Results Three hundred and thirty–one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care. There was lower cumulative incidence of seeking formal care first for preterm neonates (sub–hazard ratio SHR 0.61, P = 0.025), and those who delivered at home (SHR 0.52, P = 0.010); and higher cumulative incidence for those who reported less than normal activity (SHR 1.95, P = 0.048). The main barriers to seeking formal care reported by 165 mothers included cost (n = 98, 59.4%), believing the neonate was going to die anyway (n = 29, 17.7%), and believing traditional care was more appropriate (n = 26, 15.8%). Conclusions The majority of neonates died before formal care could be sought, but formal care was more likely to be sought than informal care. There were economic and social belief barriers to care–seeking. There is a need for programs that educate caregivers about well–recognized danger signs requiring timely care–seeking, particularly for preterm neonates and those who deliver at home. PMID:27350876

  10. Usefulness of postmortem biochemistry in identification of ketosis: Diagnosis of ketoacidosis at the onset of autoimmune type 1 diabetes in an autopsy case with cold exposure and malnutrition.

    PubMed

    Tani, Naoto; Michiue, Tomomi; Chen, Jian-Hua; Oritani, Shigeki; Ishikawa, Takaki

    2016-09-01

    A severely malnourished, Japanese female in her twenties was found dead in her apartment. On autopsy, most of the findings from the internal examination were suggestive of hypothermia. Postmortem biochemistry, however, showed severely increased levels of glycated hemoglobin (HbA1c) and blood and urine glucose levels. Levels of acetone, 3-hydroxybutyric acid, and acetoacetate in various body fluids were also highly increased, indicating ketosis. The serum insulin and c-peptide levels were severely low, and subsequent testing was positive for anti-GAD antibodies. Immunohistochemical examination of the pancreatic islet cells revealed few insulin-positive cells but many glucagon-positive cells on staining. Furthermore, slight invasion of CD8-positive lymphocytes in the pancreatic islets of Langerhans was observed. Results of immunostaining of the pancreatic and bronchial epithelial tissues were partly positive for the Influenza A virus. We concluded that severe ketoacidosis associated with rapid-onset hyperglycemia due to autoimmune type 1 diabetes (AT1D) had occurred shortly before death. However, the ketosis was accompanied by hypothermia and malnutrition as well as diabetic ketoacidosis (DKA). Therefore, we retrospectively collected biochemical data on cases of hypothermia and malnutrition and compared them with the present case. Serum glucose, acetone, 3-hydroxybutyric acid, and acetoacetic acid can be used for screening and diagnosis to distinguish DKA from ketosis due to hypothermia and malnutrition. Therefore, in the present case, we diagnosed that the natural cause of death was due to AT1D. In conclusion, screening investigations for relevant biochemical markers can provide essential information for the diagnosis of metabolic disturbances, which fail to demonstrate characteristic autopsy findings. PMID:27591535

  11. Postmortem interval alters the water relaxation and diffusion properties of rat nervous tissue--implications for MRI studies of human autopsy samples.

    PubMed

    Shepherd, Timothy M; Flint, Jeremy J; Thelwall, Peter E; Stanisz, Greg J; Mareci, Thomas H; Yachnis, Anthony T; Blackband, Stephen J

    2009-02-01

    High-resolution imaging of human autopsy tissues may improve our understanding of in vivo MRI findings, but interpretation is complicated because samples are obtained by immersion fixation following a postmortem interval (PMI). This study tested the hypotheses that immersion fixation and PMI's from 0-24 h would alter the water relaxation and diffusion properties in rat cortical slice and spinal cord models of human nervous tissue. Diffusion data collected from rat cortical slices at multiple diffusion times (10-60 ms) and b-values (7-15,000 s/mm(2)) were analyzed using a two-compartment model with exchange. Rat spinal cords were characterized with standard diffusion tensor imaging (21 directions, b=1250 s/mm(2)). Switching from perfusion- to immersion-fixation at 0 h PMI altered most MRI properties of rat cortical slices and spinal cords, including a 22% decrease in fractional anisotropy (P<0.001). After 4 h PMI, cortical slice T(1) and T(2) increased 22% and 65% respectively (P<0.001), transmembrane water exchange decreased 23% (P<0.001) and intracellular proton fraction increased 25% (P=0.002). After 6 h PMI, spinal cord white matter fractional anisotropy had decreased 38% (P<0.001). MRI property changes were observed for PMIs up to 24 h. The MRI changes correlated with protease activity and histopathological signs of autolysis. Thus, immersion fixation and/or even short PMIs (4-6 h) altered the MRI properties of rat nervous tissue. This suggests comparisons between in vivo clinical MRI and MRI data from human autopsy tissues should be interpreted with caution. PMID:18996206

  12. [Civil and criminal laws regarding the donation, removal and transfer of organs (Transplantation Law) in Germany with respect to administrative and clinical autopsies].

    PubMed

    Dufková, J

    2000-07-01

    In the Federal Republic of Germany, transplantation medicine, which is relatively young and still developing, is now regulated by the law governing the donation, removal and transfer of organs (Transplantation Law--TPG) of 05. 11. 1997 and has been given a legal basis which satisfies even present-day standards. By evaluating the highly personal rights to potential organ donor and of his next-of-kin against the interests of maintaining life and health of others, the law works along the lines of the so-called extended consent solution. The basic civil law stipulations of sections 3 + 4 TPG, while protecting the donor's individual freedom of decision, give his next-of-kin or trusted confidant at or immediately following death the right to communicate his presumes wishes. In addition, it must be stated that through recent decisions handed down by the Federal Constitutional Court (Bundesverfassungsgericht) in response to various complaints, this regulation has been recognised as conforming to constitutional laws. The basic content of the penal regulations states that violations of civil law rules and trafficking in organs are an offence. Current disclosed requirements for suitable donor organs, in particular for 1998, make it appear likely that the current deficit can be eliminated by the introduction of the organisational measures contained in the law. In conclusion, the situation with regard to autopsy should be addressed since, in contrast to the federal transplantation law which applies to all states, autopsy is regulated differently and, from a legal-political standpoint, unsatisfactorily by each individual state. It is desirable that this legal ambiguity be corrected by standardising the inconsistent and at times non-existent legal stipulations. PMID:10974752

  13. Accuracy of Lipoarabinomannan and Xpert MTB/RIF Testing in Cerebrospinal Fluid To Diagnose Tuberculous Meningitis in an Autopsy Cohort of HIV-Infected Adults

    PubMed Central

    Lukande, Robert L.; Kalungi, Sam; Van Marck, Eric; Lammens, Martin; Van de Vijver, Koen; Kambugu, Andrew; Nelson, Ann M.; Colebunders, Robert; Manabe, Yukari C.

    2015-01-01

    Point-of-care tests for tuberculous meningitis (TBM) are needed. We studied the diagnostic accuracy of the lipoarabinomannan (LAM) lateral flow assay (LFA), LAM enzyme-linked immunosorbent assay (ELISA), and Xpert MTB/RIF in cerebrospinal fluid (CSF) in an autopsy cohort of Ugandan HIV-infected adults. We obtained written informed consent postmortem from the next of kin. A complete autopsy was done and CSF obtained. We performed LAM LFA (on unprepared and supernatant CSF after heating and spinning), LAM ELISA, and Xpert MTB/RIF on the CSF samples. Accuracy parameters were calculated for histopathological TBM and also for the composite standard, including Xpert MTB/RIF-positive cases. We tested CSF of 91 patients. LAM LFA had a sensitivity of 75% for definite histopathological TBM, ELISA a sensitivity of 43%, and Xpert MTB/RIF a sensitivity of 100% and specificities of 87%, 91%, and 87%, respectively. LAM LFA had a sensitivity of 50% for definite and probable histopathological TBM, ELISA a sensitivity of 38%, and Xpert MTB/RIF a sensitivity of 86% and specificities of 70%, 91%, and 87%, respectively. LAM LFA had a sensitivity of 68% for the composite standard and ELISA a sensitivity of 48% and specificities of 78% and 98%, respectively. The rapid diagnostic tests detected TBM in 22% to 78% of patients not on anti-TB treatment. Point-of-care tests have high accuracy in diagnosis of TBM in deceased HIV-infected adults. LAM LFA in CSF is a useful additional diagnostic tool. PMID:26063865

  14. Is Urinary Lipoarabinomannan the Result of Renal Tuberculosis? Assessment of the Renal Histology in an Autopsy Cohort of Ugandan HIV-Infected Adults

    PubMed Central

    Cox, Janneke A.; Lukande, Robert L.; Kalungi, Sam; Van Marck, Eric; Van de Vijver, Koen; Kambugu, Andrew; Nelson, Ann M.; Colebunders, Robert; Manabe, Yukari C.

    2015-01-01

    Objective The detection of urinary lipoarabinomannan (LAM), a mycobacterial cell wall component, is used to diagnose tuberculosis (TB). How LAM enters the urine is not known. To investigate if urinary LAM-positivity is the result of renal TB infection we correlated the outcomes of urinary LAM-antigen testing to renal histology in an autopsy cohort of hospitalized, Ugandan, HIV-infected adults. Methods We performed a complete autopsy, including renal sampling, in HIV-infected adults that died during hospitalization after written informed consent was obtained from the next of kin. Urine was collected postmortem through post-mortem catheterisation or by bladder puncture and tested for LAM with both a lateral flow assay (LFA) and an ELISA assay. Two pathologists assessed the kidney histology. We correlated the LAM-assay results and the histology findings. Results Of the 13/36 (36%) patients with a positive urinary LAM ELISA and/or LFA, 8/13 (62%) had renal TB. The remaining 5 LAM-positive patients had disseminated TB without renal involvement. Of the 23 LAM-negative patients, 3 had disseminated TB without renal involvement. The remaining LAM-negative patients had no TB infection and died mostly of fungal and bacterial infections. LAM LFA had a sensitivity of 81% and specificity of 100% to diagnose TB at any location, and the LAM ELISA a sensitivity of 63% and a specificity of 100%. 54% (7/13) LAM LFA-positive patients were not on anti-TB treatment at the time of death. Conclusion Renal TB infection explained LAM-positivity in the majority of patients. Patients with disseminated TB without renal involvement can also be diagnosed with LAM. This suggests that other mechanisms that lead to urinary LAM-positivity exist in a minority of patients. PMID:25897661

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

    PubMed

    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

  16. Ability of combined Near-Infrared Spectroscopy-Intravascular Ultrasound (NIRS-IVUS) imaging to detect lipid core plaques and estimate cap thickness in human autopsy coronary arteries

    NASA Astrophysics Data System (ADS)

    Grainger, S. J.; Su, J. L.; Greiner, C. A.; Saybolt, M. D.; Wilensky, R. L.; Raichlen, J. S.; Madden, S. P.; Muller, J. E.

    2016-03-01

    The ability to determine plaque cap thickness during catheterization is thought to be of clinical importance for plaque vulnerability assessment. While methods to compositionally assess cap integrity are in development, a method utilizing currently available tools to measure cap thickness is highly desirable. NIRS-IVUS is a commercially available dual imaging method in current clinical use that may provide cap thickness information to the skilled reader; however, this is as yet unproven. Ten autopsy hearts (n=15 arterial segments) were scanned with the multimodality NIRS-IVUS catheter (TVC Imaging System, Infraredx, Inc.) to identify lipid core plaques (LCPs). Skilled readers made predictions of cap thickness over regions of chemogram LCP, using NIRS-IVUS. Artery segments were perfusion fixed and cut into 2 mm serial blocks. Thin sections stained with Movat's pentachrome were analyzed for cap thickness at LCP regions. Block level predictions were compared to histology, as classified by a blinded pathologist. Within 15 arterial segments, 117 chemogram blocks were found by NIRS to contain LCP. Utilizing NIRSIVUS, chemogram blocks were divided into 4 categories: thin capped fibroatheromas (TCFA), thick capped fibroatheromas (ThCFA), pathological intimal thickening (PIT)/lipid pool (no defined cap), and calcified/unable to determine cap thickness. Sensitivities/specificities for thin cap fibroatheromas, thick cap fibroatheromas, and PIT/lipid pools were 0.54/0.99, 0.68/0.88, and 0.80/0.97, respectively. The overall accuracy rate was 70.1% (including 22 blocks unable to predict, p = 0.075). In the absence of calcium, NIRS-IVUS imaging provided predictions of cap thickness over LCP with moderate accuracy. The ability of this multimodality imaging method to identify vulnerable coronary plaques requires further assessment in both larger autopsy studies, and clinical studies in patients undergoing NIRS-IVUS imaging.

  17. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study

    PubMed Central

    Reddy, N. Bayapa; Hanumantha; Madithati, Pallavi; Reddy, N. Nagarjuna; Reddy, C. Sainarasimha

    2014-01-01

    Background: The statistical profile reflects a global estimate of 5.1 million deaths in 2000, which was due to injuries that accounted for 10% of deaths due to all causes. Out of this, a quarter of injury-related deaths occurred in the South-East Asian region. Road Traffic Accident (RTA) is one among the top 5 causes of morbidity and mortality in South-East Asian countries. Most common cause of blunt abdominal trauma in India is road traffic accident followed by pedestrian accidents, abdominal blows, and fall from heights. Aims: To analyze the epidemiology and pattern of fatal thoraco-abdominal injuries in road traffic accidents. Materials and Methods: An autopsy-based cross-sectional study conducted. A purposive sampling technique was applied to select the study sample of 100 post-mortems of road traffic accident between November 2008 and May 2010 subjected to medico-legal autopsy at the department of Forensic Medicine, KIMS Hospital Bangalore. Results: The majority of the victims were aged 21 to 40 years, 50 (50.0%), most of the victims were male 92 (92.0%); and male/female ratio was 11.5:1. Commonest offending agents in heavy motor vehicles were 54 (54.0%). Bony cage sustained injuries were observed in 71; out of this, fractures of ribs were observed in 45 (63.3%) victims, clavicle in 14 (19.7%), sternum was 6 (8.4%), and vertebrae 6 (8.4%) of fatal road traffic accidents. Internal thoracic injuries were observed in 26 cases. Among internal thoracic injuries, lungs were the most commonly involved organ 24 (92.3%) followed by the heart 2 (7.6%). Lung sustained more lacerations 19 (79.1%) than contusions 5 (20.8%). Internal abdominal injuries were observed in 49 cases. In road traffic accidents, the most commonly injured abdominal organs were solid organs such as liver 16 (32.6%) followed by spleen 9 (18.3%). Conclusions: Majority of the times in road traffic accidents, young and productive males were injured or lost their life. This study may help the planners to

  18. Over-representation of the APOE*4 allele in autopsy confirmed early- and late-onset sporadic Alzheimer`s disease

    SciTech Connect

    Kamboh, M.I.; DeKosky, S.T.; Ferrell, R.E.

    1994-09-01

    Apolipoprotein E binds to {beta}-amyloid peptide in senile plaques and neurofibrillary tangles in Alzheimer`s disease (AD). Recent studies have identified the APOE*4 allele as a major predisposing genetic factor for late-onset familial AD as well as in sporadic AD. Most of these association studies are based on clinically diagnosed AD cases with little data available on autopsy confirmed, definite AD. To characterize the distribution of APOE polymorphism in autopsy confirmed sporadic AD cases, we determined APOE genotypes in 111 DNA samples (aged 51-101 years) extracted from brain tissues which were available from the University of Pittsburgh Alzheimer`s Disease Research Center. The APOE data was compared between the AD group and 3 samples of population controls from Western Pennsylvania consisting of a young cohort (N=473, aged 18-48 years), middle cohort (N=473, aged 42-50 years) and an old cohort (N=870, aged 65-90 years). The frequency of the APOE*4 allele was similar in the young and middle cohorts (0.12) and slightly lower in the old cohort (0.10). However, the frequency of the APOE*4 allele was three times higher in both early-onset (<65 years; 0.36) and late-onset ({ge}65 years; 0.38) sporadic AD cases compared to the control groups (p<0.0001). In the AD cohort the frequency of the APOE*4 allele was similar across all age groups (<65, 65-75, 76-85, 86+) and so was in men and women (0.40 vs. 0.37). The E*4 homozygosity was observed in 18% of AD cases compared to 1% in each of the three control groups. The E*4 heterozygosity was present in 50% of AD cases compared to 17% in the control old cohort and 22% in both the young and middle control cohorts. These data confirm that the APOE*4 allele is a major risk factor for AD regardless of age-at-diagnosis or family history.

  19. Evaluation of combined near-IR spectroscopic (NIRS)-IVUS imaging as a means to detect lipid-rich plaque burden in human coronary autopsy specimens

    NASA Astrophysics Data System (ADS)

    Su, Jimmy L.; Grainger, Stephanie J.; Greiner, Cherry A.; Hendricks, Michael J.; Goode, Meghan M.; Saybolt, Matthew D.; Wilensky, Robert L.; Madden, Sean P.; Muller, James E.

    2016-02-01

    Intracoronary near-infrared spectroscopy (NIRS) can identify lipid in the coronary arteries, but lacks depth resolution. A novel catheter is currently in clinical use that combines NIRS with intravascular ultrasound (IVUS), which provides depth-resolved structural information via the IVUS modality. A measure designated as lipid-rich plaque burden (LRPB) has been proposed as a means to interpret the combined acoustic and optical information of NIRS-IVUS. LRPB is defined as the area created by the intersection of the NIRS lipid-rich arc with the corresponding IVUS-measured plaque burden. We determined the correlation in human coronary autopsy specimens between LRPB, a measure of lipid presence and extent available via intravascular imaging in patients, and the area of lipid-rich plaque as determined by the gold-standard of histology. Fifteen artery segments from 8 human autopsy hearts were imaged with the NIRS-IVUS system (TVC Imaging System, Infraredx Inc., Burlington, MA). Arteries were imaged in a specialty fixture that assured accurate co-registration between imaging and histology. The arteries were then fixed and divided into 2 mm blocks for histological staining. Pathological contouring of lipid-rich areas was performed on the stained thin sections for 54 lipid-rich blocks. Computation of LRPB was performed on transverse NIRS-IVUS frames corresponding to the histologic sections. The quantified LRPB was frequently higher than the lipid-rich plaque area determined by histology, because the region denoted by the EEL and lumen within the NIRS lipid-rich arc is not entirely comprised of lipid. Overall, a moderate to strong correlation (R = 0.73) was found between LRPB determined by NIRS-IVUS imaging and the lipid-rich plaque area determined by histology. LRPB, which can be measured in patients with NIRS-IVUS imaging, corresponds to the amount of lipid-rich plaque in a coronary artery. LRPB should be evaluated in prospective clinical trials for its ability to

  20. Instantaneous death due to transorbital reverse penetration of a screw in an accidental fall: unusual autopsy case report and review of the literature.

    PubMed

    Gioia, Sara; Bacci, Mauro; Lancia, Massimo; Carlini, Luigi; Suadoni, Fabio

    2014-03-01

    We present a peculiar autopsy case of a transorbital penetrating head injury, in a male worker, after an accidental fall onto a screw not completely stuck into a wooden board. A 13-cm screw entered the cranium 9.5 cm deep, penetrating with the flat end, a condition defined in literature as "reverse penetration." The death was instantaneous and caused by a neurogenic shock due to injuries to the brain stem and the right cerebellar hemisphere. These injuries, enabled by the length of the screw, are generally described in literature as due to nontransorbital penetrations, frequently associated with posterior entry and a large intracranial injury. The ocular globe has been, furthermore, perfectly preserved thanks to its mobility in the orbit. Even the dynamic of the incident is peculiar because of the stationary nature of the penetrating object, which the victim actively fell on by accident. To the best of our knowledge, the matter is therefore a very peculiar mortal case of transorbital intracranial penetration, whose verified injuries and dynamics are absolutely atypical. The case is now under discussion, and a review of pertinent literature is performed. PMID:24457588

  1. Histologic evolution of the reactions to hemorrhage in the premature human infant's brain. A combined ultrasound and autopsy study and a comparison with the reaction in adults.

    PubMed Central

    Darrow, V. C.; Alvord, E. C.; Mack, L. A.; Hodson, W. A.

    1988-01-01

    With the development and routine use of real-time ultrasound scanning, it has been possible to collect 20 autopsy cases of infants in whom the ultrasound scan was first normal and then showed evidence of subependymal/intraventricular hemorrhage (SEH/IVH). Analysis of these cases with known postnatal origin of the hemorrhage permitted the development for the first time of a time scale to characterize the temporal evolution of the histopathologic reactions to hemorrhage in the premature human brain. This time scale was then used to define the histologic stage of the lesions in 27 other cases of infants who had a scan demonstrating SEH/IVH prior to death but who had not a previously normal scan. Only 2 cases were found to lie off the original scale, indicating a prenatal onset of the hemorrhage in about 5% of the total cases. Thus, postnatal events immediately preceding the onset of the hemorrhage are more likely to be implicated in the pathogenesis of SEH/IVH than prenatal or obstetric events. Comparison with similar reactions in the adult indicate that the early reactions by macrophages occur at about the same rate but the routine transfer of iron from macrophages to astrocytes and the much slower rate of absorption to form a cyst in the adult combine to form a complicated pattern that requires a different set of criteria for the intermediate and late stages in the adult. Images Figure 4 Figure 3 Figure 9 Figure 2 Figure 1 Figure 5 Figure 7 PMID:3276212

  2. Suicide or accident? A psychological autopsy study of suicide in youths under the age of 16 compared to deaths labeled as accidents

    PubMed Central

    2012-01-01

    Objective In the present paper, we describe suicide in youths under 16 years of age and compare their risk factors for suicide to those of older adolescents as described in the literature. Furthermore, we evaluate the possible mislabeling of suicides as accidents, and vice versa. Method We used the data from a nationwide psychological autopsy of youths 15 years and younger who had committed suicide or died in accidents in Norway from 1993 to 2004 (n = 84). We additionally constructed a suicide index to distinguish between the two causes of death. Results The young suicide victims presented, with little gender difference, fewer obvious risk factors and less suicide intent than commonly described for older adolescents. The suicide index distinguished quite well between suicides and accidents, with few cases indicating a possible mislabeling, although some suicide cases could have been labeled as uncertain. Conclusion In line with previous research, suicides in 11-15-year-olds have many similarities to suicides in older adolescents in terms of external circumstances, but they present less apparent warning signs. In our total sample of 84 deaths, there were few indications of incorrect labeling. PMID:22971572

  3. Incidence and Size of Patent Foramen Ovale During the First 10 Decades of Life: An Autopsy Study of 965 Normal Hearts

    NASA Technical Reports Server (NTRS)

    Hagen, Philip T.; Scholz, David G.; Edwards, William D.

    1984-01-01

    The incidence and size of the patent foramen ovale were studied in 965 autopsy specimens of human hearts, which were from subjects who were evenly distributed by sex and age. Neither incidence nor size of the defect was significantly different between male and female subjects. The overall incidence was 27.3%, but it progressively declined with increasing age from 34.3% during the first three decades of life to 25.4% during the 4th through 8th decades and to 20.2% during the 9th and 10th decades. Among the 263 specimens that exhibited patency in our study, the foramen ovale ranged from 1 to 19 mm in maximal potential diameter (mean, 4.9 mm). In 98% of these cases, the foramen ovale was 1 to 10 mm in diameter. The size tended to increase with increasing age, from a mean of 3.4 mm in the first decade to 5.8 mm in the 10th decade of life.

  4. The late Greco-Roman and Byzantine contribution towards the evolution of laboratory examinations of bodily excrement. Part 2: sputum, vomit, blood, sweat, autopsies.

    PubMed

    Diamandopoulos, Athanasios A; Goudas, Pavlos C

    2005-01-01

    Although the establishment of medical laboratory institutions was a continuous process that matured only after the 16th century, several attempts had already been made to attain a diagnosis by investigating bodily excrement. In the first part of our work, published in a previous issue of this journal, we presented data on urine, sperm, menses and stools. In this paper we present data on sputum, vomit, blood, sweat, and autopsies, thus completing the list of human materials used for laboratory examinations. All the data used are extracted from codices of Late Antiquity and Byzantium and translated by us. We did not study medical texts from the other great ancestors of Western medicine, namely Arabic and Jewish writings. From the texts cited, it is apparent that the lack of technological means was no obstacle for the doctor to create an "examinational" mind, i.e., to try to correlate the macroscopic findings in the excrement with the pathophysiological mechanism that induced them, solely with the use of the senses. This not only applies to the examination of urine, as is commonly assumed, but also to many other excrements of the upper and lower orifices of the body, as well as the human body as a whole. PMID:15653449

  5. Verbal/Social Autopsy in Niger 2012–2013: A new tool for a better understanding of the neonatal and child mortality situation

    PubMed Central

    Bensaïd, Khaled; Yaroh, Asma Gali; Kalter, Henry D; Koffi, Alain K; Amouzou, Agbessi; Maina, Abdou; Kazmi, Narjis

    2016-01-01

    Niger, one of the poorest countries in the world, recently used for the first time the integrated verbal and social autopsy (VASA) tool to assess the biological causes and social and health system determinants of neonatal and child deaths. These notes summarize the Nigerien experience in the use of this new tool, the steps taken for high level engagement of the Niger government and stakeholders for the wide dissemination of the study results and their use to support policy development and maternal, neonatal and child health programming in the country. The experience in Niger reflects lessons learned by other developing countries in strengthening the use of data for evidence–based decision making, and highlights the need for the global health community to provide continued support to country data initiatives, including the collection, analysis, interpretation and utilization of high quality data for the development of targeted, highly effective interventions. In Niger, this is supporting the country’s progress toward achieving Millennium Development Goal 4. A follow–up VASA study is being planned and the tool is being integrated into the National Health Management Information System. VASA studies have now been completed or are under way in additional sub–Saharan African countries, in each through the same collaborative process used in Niger to bring together health policy makers, program planners and development partners. PMID:26955472

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

    SciTech Connect

    Heid, K.R.; Jech, J.J.; Kathren, R.L.; Sula, M.J.

    1985-05-01

    Experience in the nuclear industry has shown that the most frequent 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.

  7. Differences between children and adolescents who commit suicide and their peers: A psychological autopsy of suicide victims compared to accident victims and a community sample

    PubMed Central

    2012-01-01

    Background The purpose of this study was to gain knowledge about the circumstances related to suicide among children and adolescents 15 years and younger. Methods We conducted a psychological autopsy, collecting information from parents, hospital records and police reports on persons below the age of 16 who had committed suicide in Norway during a 12-year period (1993-2004) (n = 41). Those who committed suicide were compared with children and adolescents who were killed in accidents during the same time period (n = 43) and with a community sample. Results: Among the suicides 25% met the criteria for a psychiatric diagnosis and 30% had depressive symptoms at the time of death. Furthermore, 60% of the parents of the suicide victims reported the child experienced some kind of stressful conflict prior to death, whereas only 12% of the parents of the accident victims reported such conflicts. Conclusion One in four suicide victims fulfilled the criteria for a psychiatric diagnosis. The level of sub-threshold depression and of stressful conflict experienced by youths who committed suicide did not appear to differ substantially from that of their peers, and therefore did not raise sufficient concern for referral to professional help. PMID:22216948

  8. The Relationship between Impulsivity and Suicide Among Rural Youths Aged 15–35 Years: A Case-Control Psychological Autopsy Study1

    PubMed Central

    Lin, Lin; Zhang, Jie; Zhou, Li; Jiang, Chao

    2015-01-01

    In China, the gender ratio of suicide rates did not match the Western patterns, which was higher for females than males. However, the rural men were at relatively high risk of suicide in Liaoning province. Impulsivity was an important factor of suicide behaviors, but there was a lack of studies in China. This research aimed to study the relationship between impulsive personality traits and suicidal behavior among Chinese rural youths. Suicides were consecutively sampled from six randomly selected counties in Liaoning Province in China. Between 2005 and 2007, a total of 162 suicide victims were enrolled in the study along with 162 community controls matched for age, gender, and location. The psychological autopsy method was used to collect data from informants knowledgeable about the selected suicide victims and controls. The results showed the suicide victims in the study were more likely to demonstrate dysfunctional impulsivity and less likely to demonstrate functional impulsivity compared with the controls. Mental disorders, acute negative life events and dysfunctional impulsivity contributed to the risk of suicide; educational and functional impulsivity were protective factors. Suicide prevention efforts in rural China may address impulsivity. PMID:26110614

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

    PubMed

    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

  10. [Disease-modifying factors in chronic polyarthritis. Correlations amongsystemic vasculitis, secondary amyloidosis, septic infections and occurrence of miliary epitheloid-cell granuloma. A review of autopsies].

    PubMed

    Bély, M; Apáthy, A

    1993-03-01

    The following findings were obtained from autopsies performed on 169 deceased with chronic polyarthritis (CP): systemic vasculitis in 26 cases (15.4%), systemic secondary amyloidosis in 32 cases (18.9%), sepsis in 13 cases (7.7%) and miliary epithelioid-cell granulomatosis (probably tuberculosis) in six cases (3.6%). Vasculitis was combined with amyloidosis in five patients, with sepsis in two and with miliary epithelioid-cell granulomatosis in four. Critical random check, using the Mann-Whitney test, did not support significance of relationship between vasculitis and amyloidosis or fatal sepsis, whereas significant correlations were found to exist in CP cases between vasculitis and miliary epithelioid-cell granulomatosis (P < 0.005). The latter had no effect on the severity of vasculitis, but the incidence of the granulomatous type of vasculitis was higher with significance (P < 0.02). The conclusion is that biopsy evidence of granulomatous vasculitis in CP patients should be followed by systematic clinical search for miliary tuberculosis because of above-average incidence of that combination. PMID:8499420

  11. Clinical Significance of the Soleal Vein and Related Drainage Veins, in Calf Vein Thrombosis in Autopsy Cases with Massive Pulmonary Thromboembolism

    PubMed Central

    Kageyama, Norimasa

    2015-01-01

    Objective: To clarify the histopathological characteristics of deep vein thrombosis (DVT) resulting in lethal pulmonary thromboembolism (PE). Subjects and Methods: We investigated 100 autopsy cases of PE from limb DVT. The distribution and chronology of DVT in each deep venous segment were examined. Venous segments were classified into three groups: iliofemoral vein, popliteal vein and calf vein (CV). The CV was subdivided into two subgroups, drainage veins of the soleal vein (SV) and non drainage veins of SV. Results: Eighty-nine patients had bilateral limb DVTs. CV was involved in all limbs with DVT with isolated calf DVTs were seen in 47% of patients. Fresh and organized thrombi were detected in 84% of patients. SV showed the highest incidence of DVTs in eight venous segments. The incidence of DVT gradually decreased according to the drainage route of the central SV. Proximal tips of fresh thrombi were mainly located in the popliteal vein and tibioperoneal trunk, occurring in these locations in 63% of limbs. Conclusions: SV is considered to be the primary site of DVT; the DVT then propagated to proximal veins through the drainage veins. Lethal thromboemboli would occur at proximal veins as a result of proximal propagation from calf DVTs. PMID:27087868

  12. The fatal poisoning pattern of Ankara (Turkey) and nearby cities from 2007 to June 2011: a retrospective study in forensic autopsies.

    PubMed

    Karaarslan, Bekir; Karapirli, Mustafa; Kandemir, Eyup; Kucuker, Hudaverdi; Gurler, Mukaddes; Ince, Cengiz Haluk; Akyol, Omer

    2013-11-01

    We aimed to obtain an outline of the nature and number of fatal poisonings which still appear to affect widely the population in Turkey. A total of 5921 forensic autopsies were performed between 2007 and 2011 in Ankara and nearby cities and 366 of them were fatal poisonings (219 male, 147 female). Most of the cases were between 41 and 60 years old (n = 84). Most of the fatalities were reported during winter months (48.1%). Carbon monoxide exposure was the most common reason (66.7%) within all the causes followed by medicine and narcotics (13.9%). Postmortem blood alcohol concentrations in ethyl and methyl alcohol poisonings were 385.1 ± 61.9 and 206.8 ± 138.9 mg/dL, respectively. The most common location of deaths was home (71.3%). Fatal poisonings have been a growing global problem because of some shortcomings about the socioeconomic conditions and increasing illicit drug abuse. The level of education, socioeconomic conditions, and legal approaches are very important for the prevention fatal poisonings. PMID:23865682

  13. Atypical amyotrophic lateral sclerosis with dementia mimicking frontal Pick's disease: a report of an autopsy case with a clinical course of 15 years.

    PubMed

    Tsuchiya, K; Ikeda, K; Haga, C; Kobayashi, T; Morimatsu, Y; Nakano, I; Matsushita, M

    2001-06-01

    This report concerns an autopsy case of atypical amyotrophic lateral sclerosis (ALS) with dementia mimicking frontal Pick's disease. The patient was a Japanese woman without hereditary burden who was 45 years old at the time of death. She developed abnormal behavior and amnesia at age 30, followed by disinhibition, aspontaneity, urinary incontinence, abulia, and rectal incontinence. Neurological signs compatible with ALS developed about 14 years after the disease onset. No respirator was used throughout the clinical course. Macroscopically, neuropathological examination showed atrophy of the frontotemporal lobes with accentuation in the convexities of the frontal lobes. Histologically, there was neuronal loss in the cerebral cortex, parahippocampal gyrus, amygdala, caudate nucleus, substantia nigra, brain stem motor nuclei, and anterior horns of the spinal cord, in addition to marked degeneration of the pyramidal tracts. Ubiquitin-immunoreactive neuronal inclusions were present in the frontotemporal cortical layer II neurons and motor neurons in the brain stem and spinal cord. In the hippocampal dentate granular cells, many ubiquitin-immunoreactive neurites were present without ubiquitin-immunoreactive intraneuronal inclusions. Based on these clinicopathological findings and a review of the literature, we concluded that our case was atypical ALS with dementia of long disease duration. We also note the possibility that motor neuron disease-inclusion dementia with a long clinical course may develop into ALS in the final stage of the illness. PMID:11515792

  14. Pulmonary hypoplasia on preterm infant associated with diffuse chorioamniotic hemosiderosis caused by intrauterine hemorrhage due to massive subchorial hematoma: report of a neonatal autopsy case.

    PubMed

    Yamada, Sohsuke; Marutani, Takamitsu; Hisaoka, Masanori; Tasaki, Takashi; Nabeshima, Atsunori; Shiraishi, Mika; Sasaguri, Yasuyuki

    2012-08-01

    A male infant born prematurely at 31 weeks of gestation weighed 789 g and had mildly brown-colored oral/tracheal aspirates at delivery. The amniotic fluid was also discolored, and its index was below 5. The patient died of hypoxemic respiratory and cardiac failure 2 hours after birth. The maternal profiles showed placenta previa and intrauterine growth restriction (IUGR) at 22 weeks of gestation, and revealed recurrent episodes of antenatal and substantial vaginal bleeding and oligohydramnios, indicating chronic abruption-oligohydramnios sequence. The thickened placenta, weighing 275 g, grossly displayed unevenness and diffuse opacity with green to brown discoloration in the chorioamniotic surface, and revealed chronic massive subchorial hematomas (Breus' mole) with old peripheral blood clot, circumvallation, and infarction. Microscopically, diffuse Berlin-blue staining-positive hemosiderin deposits were readily encountered in the chorioamniotic layers of the chorionic plate, consistent with diffuse chorioamniotic hemosiderosis (DCH) due to Breus' mole, accompanied by diffuse amniotic necrosis. At autopsy, an external examination showed several surface anomalies and marked pulmonary hypoplasia, 0.006 (less 0.012) of lung:body weight ratio. Since Breus' mole has a close relationship with intrauterine hemorrhage, resulting in DCH, IUGR, and/or pulmonary hypoplasia of the newborn, the present features might be typical. PMID:22827763

  15. The high prevalence of undiagnosed prostate cancer at autopsy: implications for epidemiology and treatment of prostate cancer in the Prostate-specific Antigen-era.

    PubMed

    Jahn, Jaquelyn L; Giovannucci, Edward L; Stampfer, Meir J

    2015-12-15

    Widespread prostate-specific antigen (PSA) screening detects many cancers that would have otherwise gone undiagnosed. To estimate the prevalence of unsuspected prostate cancer, we reviewed 19 studies of prostate cancer discovered at autopsy among 6,024 men. Among men aged 70-79, tumor was found in 36% of Caucasians and 51% of African-Americans. This enormous prevalence, coupled with the high sensitivity of PSA screening, has led to the marked increase in the apparent incidence of prostate cancer. The impact of PSA screening on clinical practice is well-recognized, but its effect on epidemiologic research is less appreciated. Before screening, a larger proportion of incident prostate cancers had lethal potential and were diagnosed at advanced stage. However, in the PSA era, overall incident prostate cancer mainly is indolent disease, and often reflects the propensity to be screened and biopsied. Studies must therefore focus on cancers with lethal potential, and include long follow-up to accommodate the lead time induced by screening. Moreover, risk factor patterns differ markedly for potentially lethal and indolent disease, suggesting separate etiologies and distinct disease entities. Studies of total incident or indolent prostate cancer are of limited clinical utility, and the main focus of research should be on prostate cancers of lethal potential. PMID:25557753

  16. In vitro and in vivo percutaneous absorption of organoleads, lead salts, and inorganic lead in guinea pig and human autopsy skin

    SciTech Connect

    Bress, W.C.

    1984-01-01

    Using diffusion tubes, the degree of penetration of tetrabutyl lead, lead napthanate, lead nuolate, lead acetate and lead oxide through guinea pig skin and human skin from autopsy was measured. Tetrabutyl lead demonstrated the greatest absorption in both the guinea pig and man. Lead nuolate, lead napthanate and lead acetate followed in descending order with the human tissue. The same leads, applied to guinea pig skin, followed a similar pattern of absorption in most cases. There were no measureable amounts of lead oxide absorbed in either species. Tetrabutyl lead, lead nuolate, lead napthanate, lead acetate and lead oxide were applied to the shaved backs of guinea pigs at 300mg/kg, under an occluded wrapping, daily, for seven days. Tissue concentrations of lead were highest when tetrabutyl lead was applied. The application of lead nuolate caused higher concentrations of lead in liver and kidney, than the corresponding applicaiton of lead napthanate. Lead acetate was poorly absorbed. No absorption was evidenced in the case of the lead oxide application. Light microscopic examination of integument, treated with tetrabutyl lead, revealed marked inflammation within the dermis. Inflammation was less marked in the integument of animals treated with lead napthanate and lead nuolate. Staining with sodium rhodizonate proved unsuccessful, but treatment of tissues exposed to lead nuolate and lead napthanate with ammonium sulfide showed evidence of lead on the stratum corneum and hair shafts. Correlation between the in vitro and in vivo data, as well as the comparison of human and guinea pig results, are discussed.

  17. Tattoo types and frequencies in New Mexican white hispanics and white non-hispanics: autopsy data from homicidal and accidental deaths, 2002-2005.

    PubMed

    Komar, Debra; Lathrop, Sarah

    2008-12-01

    Tattoos serve as a form of forensic personal identification and providing evidence of possible gang affiliation, incarceration history, and high-risk lifestyle factors such as drug use. Despite their forensic applications, tattoo typology and frequencies in specific ethnic and racial groups are underreported and poorly understood. This study examined autopsy records from the New Mexico Office of the Medical Investigator from 2002 to 2005. A total of 3430 individuals (1666 white Hispanics; 1764 white non-Hispanics), aged 18 to 100 years, with homicidal or accidental manners of death were included in the study. In addition to demographic information, data were recorded on the presence/absence of tattoos, singular or multiple tattoos, and the language of text tattoos. Tattoos depicting gang or religious symbolism were also recorded. Results indicate statistically significant differences in tattoo frequencies by ethnicity (52% Hispanic vs. 29.5% non-Hispanic), sex (46.8% men vs. 25.9% women) and age cohort. Hispanics were more likely to have multiple tattoos than non-Hispanics (41% and 19%, respectively), and were 4.67 times more likely to have a religious tattoo and 7.13 times more likely to have a gang tattoo than non-Hispanics. Significant patterns in language of text tattoos and correlations with manner of death were also noted. PMID:19259010

  18. Single-stranded DNA as an immunohistochemical marker of neuronal damage in human brain: an analysis of autopsy material with regard to the cause of death.

    PubMed

    Michiue, Tomomi; Ishikawa, Takaki; Quan, Li; Li, Dong-Ri; Zhao, Dong; Komatsu, Ayumi; Zhu, Bao-Li; Maeda, Hitoshi

    2008-07-01

    Single-stranded DNA (ssDNA) is a marker of apoptosis and programmed cell death, which appears prior to DNA fragmentation during delayed neuronal death. The present study investigated the immunohistochemical distribution of ssDNA in the brain to investigate apoptotic neuronal damage with regard to the cause of death in medicolegal autopsy cases (n=305). Neuronal immunopositivity for ssDNA was globally detected in the brain, independent of the age, gender of subjects and postmortem interval, and depended on the cause of death. Higher positivity was typically found in the pallidum for delayed brain injury death and fatal carbon monoxide intoxication, and in the cerebral cortex, pallidum and substantia nigra for drug intoxication. For mechanical asphyxiation, a high positivity was detected in the cerebral cortex and pallidum, while the positivity was low in the substantia nigra. The neuronal ssDNA increased during the survival period within about 24h at each site, depending on the type of brain injury, and in the substantia nigra for other blunt injuries. The neuronal positivity was usually lower for drowning and acute ischemic disease. Topographical analysis of ssDNA-positive neurons may contribute to investigating the cause of brain damage and survival period after a fatal insult. PMID:18462896

  19. Evaluation of postmortem S100B levels in the cerebrospinal fluid with regard to the cause of death in medicolegal autopsy.

    PubMed

    Li, Dong-Ri; Michiue, Tomomi; Zhu, Bao-Li; Ishikawa, Takaki; Quan, Li; Zhao, Dong; Yoshida, Chiemi; Chen, Jian-Hua; Wang, Qi; Komatsu, Ayumi; Azuma, Yoko; Maeda, Hitoshi

    2009-04-01

    Previous studies have suggested the usefulness of the postmortem serum S100B level as a marker of the severity of brain damage. In this study, we investigated the S100B level in the cerebrospinal fluid (CSF) in serial autopsy cases (n=216, within 3 days postmortem), including those of blunt injury (n=34: fatal head injury, n=20; others, n=14), sharp instrument injury (n=9), mechanical asphyxiation (n=19), drowning (n=11), fire fatality (n=26), intoxication (n=20), hypothermia (cold exposure, n=16), hyperthermia (heat stroke, n=9), acute cardiac death (n=52) and pneumonia (n=20). The CSF S100B level showed a moderate postmortem time-dependent increase for acute cardiac death (r=0.58, p<0.0001) and asphyxia (r=0.741, p<0.001). In cases of survival time within 48 h, drowning and hypothermia usually showed a lower CSF S100B level (around 500 ng/ml), and the level was higher for delayed head injury death, asphyxia, intoxication, and hyperthermia (around 1500 ng/ml) (p<0.05). In fatal head injury cases, however, CSF S100B did not correlate with the survival time or postmortem interval. A CSF S100B level of >2000 ng/ml in the early postmortem period might be considered a biochemical sign of fatally severe brain damage. PMID:19366640

  20. Quantitative analysis of ubiquitin-immunoreactivity in the midbrain periaqueductal gray matter with regard to the causes of death in forensic autopsy.

    PubMed

    Quan, Li; Ishikawa, Takaki; Michiue, Tomomi; Li, Dong-Ri; Zhao, Dong; Zhu, Bao-Li; Maeda, Hitoshi

    2005-05-01

    The aim of the present study was to examine Ub-immunoreactivity in the midbrain periaqueductal gray matter (PGM), which is involved in pain processing and modulation, in forensic autopsy cases (n=273) in relation to the causes of death: acute deaths from blunt injuries (n=75), sharp weapon injuries (n=36), fatal asphyxiation (n=22), drownings (n=16: freshwater, n=9; saltwater, n=7), fire fatalities (n=64), poisoning (n=12), hyperthermia (n=5), hypothermia (n=5), delayed deaths from blunt head injury (n=8), acute cardiac deaths (n=24), and acute cerebrovascular strokes (n=6). The Ub-immunoreactivity was clearly observed in the nuclei of the PGM neurons, showing no postmortem interference or age-dependency. A higher value was observed in blunt injuries, fire fatalities and also in saltwater drowning, hyperthermia and delayed head injury deaths. These findings suggest a complicated mechanism for the ubiquitination of PGM neurons, to which multiple factors including the intensity and duration of pains possibly under alert consciousness, traumatic and metabolic neurodegeneration may contribute. PMID:15847822

  1. Evaluation of postmortem calcium and magnesium levels in the pericardial fluid with regard to the cause of death in medicolegal autopsy.

    PubMed

    Li, Dong-Ri; Quan, Li; Zhu, Bao-Li; Ishikawa, Takaki; Michiue, Tomomi; Zhao, Dong; Yoshida, Chiemi; Chen, Jian-Hua; Wang, Qi; Komatsu, Ayumi; Azuma, Yoko; Maeda, Hitoshi

    2009-04-01

    Previous studies have suggested the usefulness of postmortem serum calcium (Ca) and magnesium (Mg) for investigating cause of death. The present study investigated their levels in the pericardial fluid of serial autopsy cases of adults within 48 h postmortem (n=385), including fatalities from blunt injury (n=57), sharp instrument injury (n=9), mechanical asphyxiation (n=28), salt- and freshwater drowning (n=14 and n=61, respectively), fire fatality (n=35), intoxication (n=23), hypothermia (cold exposure, n=12), hyperthermia (heat stroke, n=7), acute cardiac death (ACD, n=86), pneumonia (n=9) and spontaneous cerebral hemorrhage (n=11). The pericardial Ca level was independent of the postmortem interval, showing a value similar to that of the clinical reference range in cases other than saltwater drowning, while the Mg level was higher than the clinical reference range and showed a mild postmortem time-dependent increase. Pericardial Ca was significantly higher for saltwater drowning than other groups, and a lower level was seen for hyperthermia, and some cases of blunt injury and intoxication. The Mg level was also significantly higher for saltwater drowning than the other groups, and showed a higher level for sharp instrument injury, but a lower level for hypothermia. The Mg/Ca ratio was higher for sharp instrument injury and saltwater drowning, but was lower for hypothermia. These findings suggest that postmortem pericardial Ca and Mg can be used to investigate the cause of death, especially for saltwater drowning, hypothermia and hyperthermia. PMID:19251451

  2. Verbal/Social Autopsy in Niger 2012-2013: A new tool for a better understanding of the neonatal and child mortality situation.

    PubMed

    Bensaïd, Khaled; Yaroh, Asma Gali; Kalter, Henry D; Koffi, Alain K; Amouzou, Agbessi; Maina, Abdou; Kazmi, Narjis

    2016-06-01

    Niger, one of the poorest countries in the world, recently used for the first time the integrated verbal and social autopsy (VASA) tool to assess the biological causes and social and health system determinants of neonatal and child deaths. These notes summarize the Nigerien experience in the use of this new tool, the steps taken for high level engagement of the Niger government and stakeholders for the wide dissemination of the study results and their use to support policy development and maternal, neonatal and child health programming in the country. The experience in Niger reflects lessons learned by other developing countries in strengthening the use of data for evidence-based decision making, and highlights the need for the global health community to provide continued support to country data initiatives, including the collection, analysis, interpretation and utilization of high quality data for the development of targeted, highly effective interventions. In Niger, this is supporting the country's progress toward achieving Millennium Development Goal 4. A follow-up VASA study is being planned and the tool is being integrated into the National Health Management Information System. VASA studies have now been completed or are under way in additional sub-Saharan African countries, in each through the same collaborative process used in Niger to bring together health policy makers, program planners and development partners. PMID:26955472

  3. Contribution of forensic autopsy to scene reconstruction in mass fire casualties: a case of alleged arson on a floor consisting of small compartments in a building.

    PubMed

    Michiue, Tomomi; Ishikawa, Takaki; Oritani, Shigeki; Maeda, Hitoshi

    2015-01-01

    A fire is an important cause of mass disasters, involving various forensic issues. Before dawn on an early morning, 16 male visitors in their twenties to sixties were killed in a possibly incendiary fire at a 'private video parlor' consisting of small compartments in a building. The main causes of death as determined by forensic autopsy were acute carbon monoxide (CO) intoxication for all of the 15 found-dead victims, and hypoxic-ischemic encephalopathy following acute CO intoxication for a victim who died in hospital. Burns were mild (<20% of body surface) in most victims, except for three victims found between the entrance and the estimated fire-outbreak site; thus, identification was completed without difficulty, supported by DNA analysis. Blood carboxyhemoglobin saturation (COHb) was higher for victims found dead in the inner area. Blood cyanide levels were sublethal, moderately correlated to COHb, but were higher in victims found around the estimated fire-outbreak site. There was no evidence of thinner, alcohol or drug abuse, or an attack of disease as a possible cause of an accidental fire outbreak. These observations contribute to evidence-based reconstruction of the fire disaster, and suggest how deaths could have been prevented by appropriate disaster measures. PMID:25311374

  4. Human cranial vault thickness in a contemporary sample of 1097 autopsy cases: relation to body weight, stature, age, sex and ancestry.

    PubMed

    De Boer, H H Hans; Van der Merwe, A E Lida; Soerdjbalie-Maikoe, V Vidija

    2016-09-01

    The relation between human cranial vault thickness (CVT) and various elements of the physical anthropological biological profile is subject of ongoing discussion. Some results seem to indicate no correlation between CVT and the biological profile of the individual, whereas other results suggest that CVT measurements might be useful for identification purposes. This study assesses the correlation between CVT and body weight, stature, age, sex, and ancestry by reviewing data of 1097 forensic autopsies performed at the Netherlands Forensic Institute (NFI). In subadults (younger than 19 years of age at the time of death), all frontal, temporal, and occipital CVT measurements correlated moderately to strongly with indicators of growth (body weight, stature, and age). Neither sex nor ancestry correlated significantly with cranial thickness. In adults, body weight correlated with all CVT measurements. No meaningful correlation was found between CVT and stature or age. Females showed to have thicker frontal bones, and the occipital region was thicker in the Negroid subsample. All correlation in the adult group was weak, with the distribution of cranial thickness overlapping for a great deal between the groups. Based on these results, it was concluded that CVT generally cannot be used as an indicator for any part of the biological profile. PMID:26914798

  5. "Whenever they cry, I cry with them": Reciprocal relationships and the role of ethics in a verbal autopsy study in Papua New Guinea.

    PubMed

    Gouda, H N; Kelly-Hanku, A; Wilson, L; Maraga, S; Riley, I D

    2016-08-01

    Verbal autopsy (VA) methods usually involve an interview with a recently bereaved individual to ascertain the most probable cause of death when a person dies outside of a hospital and/or did not receive a reliable death certificate. A number of concerns have arisen around the ethical and social implications of the use of these methods. In this paper we examine these concerns, looking specifically at the cultural factors surrounding death and mourning in Papua New Guinea, and the potential for VA interviews to cause emotional distress in both the bereaved respondent and the VA fieldworker. Thirty one semi-structured interviews with VA respondents, the VA team and community relations officers as well as observations in the field and team discussions were conducted between June 2013 and August 2014. While our findings reveal that VA participants were often moved to cry and feel sad, they also expressed a number of ways they benefited from the process, and indeed welcomed longer transactions with the VA interviewers. Significantly, this paper highlights the ways in which VA interviewers, who have hitherto been largely neglected in the literature, navigate transactions with the participants and make everyday decisions about their relationships with them in order to ensure that they and VA interviews are accepted by the community. The role of the VA fieldworker should be more carefully considered, as should the implications for training and institutional support that follow. PMID:27376593

  6. Trends in non-communicable disease mortality among adult residents in Nairobi's slums, 2003–2011: applying InterVA-4 to verbal autopsy data

    PubMed Central

    Oti, Samuel O.; van de Vijver, Steven; Kyobutungi, Catherine

    2014-01-01

    Background About 80% of deaths from non-communicable diseases (NCDs) occur in developing countries such as Kenya. However, not much is known about the burden of NCDs in slums, which account for about 60% of the residences of the urban population in Kenya. This study examines trends in NCD mortality from two slum settings in Nairobi. Design We use verbal autopsy data on 1954 deaths among adults aged 35 years and older who were registered in the Nairobi Urban Health and Demographic Surveillance System between 2003 and 2011. InterVA-4, a computer-based program, was used to assign causes of death for each case. Results are presented as annualized cause-specific mortality rates (CSMRs) and cause-specific mortality fractions (CSMFs) by sex. Results The CSMRs for NCDs did not appear to change significantly over time for both males and females. Among males, cardiovascular diseases (CVDs) and neoplasms were the leading NCDs – contributing CSMFs of 8 and 5%, respectively, on average over time. Among females, CVDs contributed a CSMF of 14% on average over time, while neoplasms contributed 8%. Communicable diseases and related conditions remained the leading causes of death, contributing a CSMF of over 50% on average in males and females over time. Conclusions Our findings are consistent with the Global Burden of Disease 2010 study which shows that communicable diseases remain the dominant cause of death in Africa, although NCDs were still significant contributors to mortality. We recommend an integrated approach towards disease prevention that focuses on health systems strengthening in resource-limited settings such as slums. PMID:25377336

  7. Pattern of Head Injuries (Cranio-cerebral) due to Homicide in Association with Other Injuries: A Retrospective Post-mortem Study Autopsied at Dhaka Medical College Morgue House.

    PubMed

    Akber, E B; Alam, M T; Rahman, K M; Jahan, I; Musa, S A

    2016-04-01

    Annually, homicide contributes to a greater number of the total head injury cases. This retrospective study was conducted from 1(st) January 2009 to 31(st)December 2011 at Dhaka Medical College Mortuary. During this study period of three years a total of 15300 autopsies were done of which 5649 cases (36.84%) were of head injuries. Of them 747(13.22%) were of homicidal, 4080(72.22%) road-traffic accidents, 502(8.88%) accidental and 320(5.66%) cases of fall from heights. Three hundred ninety eight (398) urban cases (53.27%) out numbered 307 rural cases (41.09%) followed by 42 unknown cases (5.62%). Most cases belong to the younger age group i.e. 21-40 years (43.34%) with male preponderance 470(63.10%). Defense wounds were present in 281 cases (37.82%) out of the total 747 homicidal head injuries. There were 206(27.57%) upper limb, 176(23.56%) spinal, 139(18.60%) abdominal, 135(18.07%) thoracic, 58(7.76%) lower limb and 33(4.41%) pelvic injuries found as associated injury. There were 258(34.53%) fractures of occipital followed by 209(28.29%) parietal, 113(15.01%) frontal, 104(13.75%) temporal, 24(3.21%) ant. Cranial fossa, 23(3.07%) post. Cranial fossa and 16(2.08%) of middle cranial fossa fractures. Extradural haemorrhage was more i.e. 434 cases (58.43%) followed by subdural, combination of all, subarachnoid and intra-cerebral haemorrhages. Cases of concussion were more common i.e. 445(59.75%) than lacerated and combination of them. Blunt weapon tops the list of causative weapons i.e. 669(89.22%) than firearms 59(8.07%) and sharp pointed weapons 19(2.68%). PMID:27277363

  8. Unnatural Deaths in Shanghai from 2000 to 2009: A Retrospective Study of Forensic Autopsy Cases at the Shanghai Public Security Bureau

    PubMed Central

    Lin, Jun-Yi; Ma, Kai-Jun; Li, Bei-Xu

    2015-01-01

    Shanghai is the most developed city in China and has a soaring population. This study uses forensic epidemiology to determine the relationship between unnatural deaths and the development in Shanghai, based on recently released forensic autopsy cases from the 2000s at the Shanghai Public Security Bureau (SPSB). There were 5425 accidental deaths, 2696 homicides, 429 suicides, 186 natural deaths, and 1399 deaths of undetermined cause. There was a male-to-female ratio of 2.02:1, and the average age was 40.9±18.7 years. Traffic accidents (84.2%) were the number one cause of accidental deaths, which decreased during the study period. Sharp force injury (50.6%) was the leading cause of homicides, different from Western countries, where firearms are the leading cause. Hanging (24.5%) was the leading cause of suicides, whereas drug and chemical intoxication was the leading cause in the previous decade; pesticide ingestion decreased in the 2000s. In addition to traffic accidents, manual strangulation was the leading cause of death in childhood fatalities. Children under age 2 were vulnerable to homicides. In the 2000s, there were a large number of drug overdoses, and illegal medical practices and subway-related deaths first appeared in Shanghai. A new type of terrorist attack that involved injecting people with syringes in public places was reflected in the SPSB archives. The forensic epidemiology and changes in unnatural deaths in this decade reflected their relationship with the law, policy and changes in Shanghai. Illegal medical practices, subway-related deaths and terrorist attacks were closely related to the development in Shanghai. Identifying the risks of unnatural deaths will improve public health. PMID:26110435

  9. An autopsy case of superficial siderosis of the central nervous system accompanied by anterior sacral polycystic meningocele in neurofibromatosis type 1.

    PubMed

    Matsumoto, Arifumi; Suzuki, Hiroyoshi; Tobita, Muneshige; Hisanaga, Kinya

    2016-07-28

    A 74-year-old female patient, who was diagnosed with neurofibromatosis type 1 (NF1) at the age of 40, was admitted with complaints of flickering vision and gait disturbance for the last 2 years. On admission, neurological examination revealed mild bilateral hearing loss and ataxia in the limb and trunk. Laboratory tests revealed anti-hepatitis C virus (HCV) antibody positivity and elevated HCV RNA by real-time polymerase chain reaction. The cerebrospinal fluid examination revealed a slightly yellowish appearance with elevated total protein levels. Gradient echo T2*-weighted brain magnetic resonance imaging (MRI) demonstrated a rim of hypointense lesions surrounding the surface of the cerebellum, brainstem, frontal and temporal lobes, and thalamus, which was considered as hemosiderin depositions. From these MRI findings, she was diagnosed as having superficial siderosis of the central nervous system. Cerebral angiography revealed an aneurysm-like dilatation at the bifurcation of the right internal carotid-posterior communicating artery. (99m)Tc-ethyl cysteinate dimer single-photon emission computed tomography revealed hypoperfusion in the bilateral frontal and temporal lobes. Pelvic plain X-ray, pelvic computed tomography, and lumbosacral MRI revealed a sacral defect and an anterior sacral polycystic meningocele communicating with the spinal subarachnoid space. The patient's symptoms gradually worsened, and she died of septic shock because of pyelonephritis at the age of 77. An autopsy was performed; on pathological examination, we did not observe any findings associated with rupture of the aneurysm-like dilatation in the bifurcation of the right internal carotid-posterior communicating artery and cerebral amyloid angiopathy. Because duropathies-a new neurological disease concept-have been implicated as a cause of bleeding in the superficial siderosis, the anterior sacral polycystic meningocele, a type of duropathies, was presumed to be the most probable bleeding

  10. [Massive pulmonary thromboembolism found at autopsy in a patient with a 14-year history of polymyositis-associated nonspecific interstitial pneumonia].

    PubMed

    Takagi, Yusuke; Hagiwara, Kiyofumi; Sato, Takeo; Akiyama, Osamu; Ogura, Takashi; Tsugata, Mikiko; Takemura, Tamiko

    2008-10-01

    A 64-year-old woman with a 14-year history of refractory nonspecific interstitial pneumonia (NSIP) associated with polymyositis was admitted urgently to our hospital due to acute exacerbation of dyspnea. The first episode of dyspnea had occurred 14 years earlier and the diagnosis of cellular and fibrotic NSIP had been made by radiographic examinations and open lung biopsy. Her NSIP initially responded well to high-dose prednisolone therapy (40mg/day), but flared when the dose of prednisolone was tapered. Three years after the diagnosis of NSIP, a diagnosis of polymyositis was made based on her elevated serum level of creatinine phosphokinase and muscle biopsy findings. Her polymyositis was controlled well by prednisolone therapy, but her NSIP gradually worsened, despite treatment with several courses of methylprednisolone pulse therapy and immunosuppressive agents. She was brought to our hospital by ambulance due to acute progression of dyspnea and was admitted. Chest X-ray film revealed diffuse interstitial shadows and marked enlargement of the right atrium and bilateral pulmonary arteries. Transthoracic echocardiogram revealed severe dilatation of the right atrium and right ventricle with an estimated pulmonary artery systolic pressure of 84mmHg. She died of progressive respiratory failure on day 4 of hospitalization. Autopsy revealed massive thrombi that completely obstructed the bilateral pulmonary trunks. Histological examination revealed that these thrombi were organized, and her interstitial lung disease (ILD) was specified as fibrotic NSIP with microscopic honeycomb. Massive pulmonary thromboembolism is extremely rare in patients with polymyositis-associated NSIP, but it should be considered as a possible cause of acute exacerbation of respiratory failure. This case provides valuable information on the clinical and pathological course of polymyositis-associated NSIP. PMID:19044031

  11. Comprehensive investigation of postmortem glucose levels in blood and body fluids with regard to the cause of death in forensic autopsy cases.

    PubMed

    Chen, Jian-Hua; Michiue, Tomomi; Inamori-Kawamoto, Osamu; Ikeda, Sayuko; Ishikawa, Takaki; Maeda, Hitoshi

    2015-11-01

    The serum glucose level is regulated within a narrow range by multiple factors under physiological conditions, but is greatly modified in the death process and after death. The present study comprehensively investigated glucose levels in blood and body fluids, including pericardial fluid (PCF), cerebrospinal fluid (CSF) and vitreous humor, reviewing forensic autopsy cases (n=672). Right heart blood glucose level was often higher than at other sites, and the CSF glucose level was the lowest, showing greater dissociation in acute/subacute death cases. The glucose level was higher in the diabetic (high HbA1c) than in the non-diabetic (low HbA1c) group at each site (p<0.01-0.0001). Fatal diabetic ketoacidosis cases had evidently high glucose levels at each site; whereas in the non-diabetic group, blood glucose level was higher in fatal alcohol abuse, saltwater drowning, electrocution, cerebrovascular disease and sudden cardiac death due to ischemic heart disease. Fatal methamphetamine (MA) abuse, sepsis, malnutrition (starvation) and hypoglycemia due to antidiabetics showed markedly lower blood glucose levels. Ketones in bilateral cardiac blood and PCF were increased in diabetic ketoacidosis and fatal alcohol abuse as well as in most cases of hyperthermia (heatstroke), hypothermia (cold exposure) and malnutrition. These findings suggest that combined analysis of glucose, HbA1c and ketones in blood and body fluids is useful to investigate not only fatal diabetic metabolic disorders but also death processes due to other causes, including alcohol and MA abuse, as well as thermal disorders, sepsis and malnutrition. PMID:26593993

  12. Taken to Health Care Provider or Not, Under-Five Children Die of Preventable Causes: Findings from Cross-Sectional Survey and Social Autopsy in Rural India

    PubMed Central

    Deshmukh, Vaishali; Lahariya, Chandrakant; Krishnamurthy, Sriram; Das, Manoj K.; Pandey, Ravindra M.; Arora, Narendra K.

    2016-01-01

    Background: Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets. Materials and Methods: A cross-sectional survey covering rural areas of 16 districts from eight states across India was conducted to understand the causes of deaths and the health-seeking patterns of caregivers prior to the death of such children. Mothers of the deceased children were interviewed. The physician review process was used to assign cause of death. The qualitative data were analyzed as per standard methods, while STATA version 10 was used for analysis of quantitative data. Findings: A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers. Conclusion: The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India. PMID:27051085

  13. APOL1 Risk Alleles Are Associated with Exaggerated Age-Related Changes in Glomerular Number and Volume in African-American Adults: An Autopsy Study.

    PubMed

    Hoy, Wendy E; Hughson, Michael D; Kopp, Jeffrey B; Mott, Susan A; Bertram, John F; Winkler, Cheryl A

    2015-12-01

    APOL1 genetic variants contribute to kidney disease in African Americans. We assessed correlations between APOL1 profiles and renal histological features in subjects without renal disease. Glomerular number (N glom) and mean glomerular volume (V glom) were measured by the dissector/fractionator method in kidneys of African-American and non-African-American adults without renal disease, undergoing autopsies in Jackson, Mississippi. APOL1 risk alleles were genotyped and the kidney findings were evaluated in the context of those profiles. The proportions of African Americans with none, one, and two APOL1 risk alleles were 38%, 43%, and 19%, respectively; 38% of African Americans had G1 allele variants and 31% of African Americans had G2 allele variants. Only APOL1-positive African Americans had significant reductions in N glom and increases in V glom with increasing age. Regression analysis predicted an annual average loss of 8834 (P=0.03, sex adjusted) glomeruli per single kidney over the first 38 years of adult life in African Americans with two risk alleles. Body mass index above the group medians, but below the obesity definition of ≥ 30 kg/m(2), enhanced the expression of age-related changes in N glom in African Americans with either one or two APOL1 risk alleles. These findings indicate that APOL1 risk alleles are associated with exaggerated age-related nephron loss, probably decaying from a larger pool of smaller glomeruli in early adult life, along with enlargement of the remaining glomeruli. These phenomena might mark mechanisms of accentuated susceptibility to kidney disease in APOL1-positive African Americans. PMID:26038529

  14. Record-linkage comparison of verbal autopsy and routine civil registration death certification in rural north-east South Africa: 2006–09

    PubMed Central

    Joubert, Jané; Bradshaw, Debbie; Kabudula, Chodziwadziwa; Rao, Chalapati; Kahn, Kathleen; Mee, Paul; Tollman, Stephen; Lopez, Alan D; Vos, Theo

    2014-01-01

    Background: South African civil registration (CR) provides a key data source for local health decision making, and informs the levels and causes of mortality in data-lacking sub-Saharan African countries. We linked mortality data from CR and the Agincourt Health and Socio-demographic Surveillance System (Agincourt HDSS) to examine the quality of rural CR data. Methods: Deterministic and probabilistic techniques were used to link death data from 2006 to 2009. Causes of death were aggregated into the WHO Mortality Tabulation List 1 and a locally relevant short list of 15 causes. The matching rate was compared with informant-reported death registration. Using the VA diagnoses as reference, misclassification patterns, sensitivity, positive predictive values and cause-specific mortality fractions (CSMFs) were calculated for the short list. Results: A matching rate of 61% [95% confidence interval (CI): 59.2 to 62.3] was attained, lower than the informant-reported registration rate of 85% (CI: 83.4 to 85.8). For the 2264 matched cases, cause agreement was 15% (kappa 0.1083, CI: 0.0995 to 0.1171) for the WHO list, and 23% (kappa 0.1631, CI: 0.1511 to 0.1751) for the short list. CSMFs were significantly different for all but four (tuberculosis, cerebrovascular disease, other heart disease, and ill-defined natural) of the 15 causes evaluated. Conclusion: Despite data limitations, it is feasible to link official CR and HDSS verbal autopsy data. Data linkage proved a promising method to provide empirical evidence about the quality and utility of rural CR mortality data. Agreement of individual causes of death was low but, at the population level, careful interpretation of the CR data can assist health prioritization and planning. PMID:25146564

  15. Unnatural deaths in Shanghai from 2000 to 2009: a retrospective study of forensic autopsy cases at the Shanghai Public Security Bureau.

    PubMed

    He, Meng; Fang, You-Xin; Lin, Jun-Yi; Ma, Kai-Jun; Li, Bei-Xu

    2015-01-01

    Shanghai is the most developed city in China and has a soaring population. This study uses forensic epidemiology to determine the relationship between unnatural deaths and the development in Shanghai, based on recently released forensic autopsy cases from the 2000s at the Shanghai Public Security Bureau (SPSB). There were 5425 accidental deaths, 2696 homicides, 429 suicides, 186 natural deaths, and 1399 deaths of undetermined cause. There was a male-to-female ratio of 2.02:1, and the average age was 40.9±18.7 years. Traffic accidents (84.2%) were the number one cause of accidental deaths, which decreased during the study period. Sharp force injury (50.6%) was the leading cause of homicides, different from Western countries, where firearms are the leading cause. Hanging (24.5%) was the leading cause of suicides, whereas drug and chemical intoxication was the leading cause in the previous decade; pesticide ingestion decreased in the 2000s. In addition to traffic accidents, manual strangulation was the leading cause of death in childhood fatalities. Children under age 2 were vulnerable to homicides. In the 2000s, there were a large number of drug overdoses, and illegal medical practices and subway-related deaths first appeared in Shanghai. A new type of terrorist attack that involved injecting people with syringes in public places was reflected in the SPSB archives. The forensic epidemiology and changes in unnatural deaths in this decade reflected their relationship with the law, policy and changes in Shanghai. Illegal medical practices, subway-related deaths and terrorist attacks were closely related to the development in Shanghai. Identifying the risks of unnatural deaths will improve public health. PMID:26110435

  16. Evaluation of a teaching strategy based on integration of clinical subjects, virtual autopsy, pathology museum, and digital microscopy for medical students**

    PubMed Central

    Diaz-Perez, Julio A.; Raju, Sharat; Echeverri, Jorge H.

    2014-01-01

    Background: Learning pathology is fundamental for a successful medical practice. In recent years, medical education has undergone a profound transformation toward the development of an integrated curriculum incorporating both basic science and clinical material. Simultaneously, there has been a shift from a magisterial teaching approach to one centered around problem-based learning. Now-a-days, informatics tools are expected to help better implement these strategies. Aim: We applied and evaluated a new teaching method based on an active combination of clinical problems, gross pathology, histopathology, and autopsy pathology, all given through informatics tools, to teach a group of medical students at the Universidad de Santander, Colombia. Design: Ninety-four medical students were followed in two consecutive semesters. Students were randomized to receive teaching either through traditional methodology or through the new integrated approach. Results: There was no significant difference between the intervention group and the control group at baseline. At the end of the study, the scores in the intervention group were significantly higher compared to the control group (3.91/5.0 vs. 3.33/5.0, P = 0.0008). Students and tutors endorsed the benefits of the integrated approach. Participants were very satisfied with this training approach and rated the program an 8.7 out of 10, on average. Conclusion: This study confirms that an integrated curriculum utilizing informatics systems provides an excellent opportunity to associate pathology with clinical medicine early in training of medical students. This can be possible with the use of virtual microscopy and digital imaging. PMID:25191624

  17. Combined analyses of creatine kinase MB, cardiac troponin I and myoglobin in pericardial and cerebrospinal fluids to investigate myocardial and skeletal muscle injury in medicolegal autopsy cases.

    PubMed

    Wang, Qi; Michiue, Tomomi; Ishikawa, Takaki; Zhu, Bao-Li; Maeda, Hitoshi

    2011-09-01

    Creatine kinase-MB (CK-MB), cardiac troponin I (cTnI) and myoglobin (Mb) are biochemical markers of myocardial injury; however, Mb is more abundant in skeletal muscles. The present study involved analysis of these markers in pericardial and cerebrospinal fluids (PCF and CSF) from serial medicolegal autopsy cases (n=295, within 48h) to examine their efficacy in determining the cause of death. Although these markers showed a slight postmortem time-dependent elevation, except for CK-MB in CSF, the distribution depended on the cause of death. Mb levels in PCF and CSF were higher in fatal hyperthermia (heat stroke) and methamphetamine abuse, and CK-MB in both fluids was also higher in the latter. In psychotropic drug intoxication, CK-MB, cTnI and Mb were higher in PCF, but only cTnI was elevated in CSF. In electrocution and cerebrovascular disease, each marker was higher in PCF and also relatively high in CSF. PCF cTnI level was higher in acute pulmonary embolism without significant elevation of any other markers, whereas CSF CK-MB was higher in acute blunt brain injury death and methamphetamine abuse. In most cases of delayed brain injury death, hypothermia (cold exposure) and pneumonia, these markers were low or intermediate in both PCF and CSF; however, sudden cardiac death, asphyxiation and fire fatality cases showed few characteristic findings. These observations suggest that combined analyses of these markers in postmortem PCF and CSF, in addition to blood samples, are helpful for evaluating the severity of myocardial and/or skeletal muscle damage in death processes, in particular for investigating deaths due to hyperthermia, hypothermia, electrocution and intoxication. PMID:21683643

  18. Using verbal and social autopsies to explore health-seeking behaviour among HIV-positive women in Kenya: a retrospective study

    PubMed Central

    2014-01-01

    Background There is limited understanding of the factors that influence decisions to seek HIV care and treatment services in community settings. The aim of this study was to explore the socio-cultural and health system factors affecting health-seeking behaviour among deceased women in Kenya who were living with HIV at the time of death. Methods Out of a total of 796 deaths for which a caregiver was available to provide information, retrospective data were drawn from verbal and social autopsies administered to caregivers of 218 women who had died of AIDS-related illnesses aged 15 to 49 years. Information was collected on essential elements of the care-seeking process from the onset of severe illness episodes and analysed using qualitative and quantitative techniques. Results Results from the quantitative data showed that poor women were less likely to access formal health services (OR = 0.2; p < 0.001) compared to non-poor women. The qualitative data showed that socioeconomic status, poor knowledge and understanding of AIDS-related illness, distance to facility and transportation costs, medical pluralism, stigma, low HIV risk perception, lack of family support and health care system barriers contributed to delays/constraints in seeking care. Conclusions The findings highlight important issues that have implications for addressing challenges faced by women living with HIV, including non-adherence to treatment regimen and late diagnosis of HIV. Provision of transportation subsidies as part of the national social safety-net strategy can help in addressing financial constraints associated with transportation costs among poor women living with HIV. PMID:24968717

  19. 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)

    PubMed Central

    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 the XP-A (XP12BE) patient, numerous skin cancers in the XP-A and two XP-C (XP24BE and XP1BE) patients and only few skin cancers in the XP-D patient. Two XP-C patients developed internal neoplasms including glioblastoma in XP24BE and uterine adenocarcinoma in XP1BE. At autopsy, the brains of the 44 yr XP-A and the 45 yr XP-D patients were profoundly atrophic and characterized microscopically by diffuse neuronal loss, myelin pallor and gliosis. Unlike the XP-A patient, the XP-D patient had a thickened calvarium, and the brain showed vacuolization of the neuropil in the cerebrum, cerebellum and brainstem, and patchy Purkinje cell loss. Axonal neuropathy and chronic denervation atrophy of the skeletal muscles were observed in the XP-A patient, but not in the XP-D patient. Conclusions These clinical manifestations and autopsy findings indicate advanced involvement of the central and peripheral nervous system. Despite similar defects in DNA repair, different clinicopathological phenotypes are seen in the four cases, and therefore distinct patterns of neurodegeneration characterize XP-D, XP-A and XP-C patients. PMID:24252196

  20. An autopsy case of frontotemporal lobar degeneration with the appearance of fused in sarcoma inclusions (basophilic inclusion body disease) clinically presenting corticobasal syndrome.

    PubMed

    Matsumoto, Arifumi; Suzuki, Hiroyoshi; Fukatsu, Reiko; Shimizu, Hiroshi; Suzuki, Yasushi; Hisanaga, Kinya

    2016-02-01

    We describe an autopsy case of basophilic inclusion body disease (BIBD), a subtype of frontotemporal lobar degeneration (FTLD) with the appearance of fused in sarcoma (FUS) inclusions (FTLD-FUS), clinically presenting corticobasal syndrome (CBS). A 54-year-old man initially developed worsening of stuttering and right hand clumsiness. Neurological examinations revealed rigidity in the right upper and lower extremities, buccofacial apraxia, and right-side dominant limb-kinetic and ideomotor apraxia. Neuroimaging showed asymmetric left-dominant brain atrophy and a cerebral blood flow reduction in the ipsilateral frontal region. At 56 years, his apraxia had advanced, and ideational apraxia was observed. Furthermore, the asymmetry in the limb-kinetic and ideomotor apraxia had disappeared, and both conditions had become bilateral. He had a new onset of aphasia. His symptoms progressed and he died 9 years after the initial symptoms. The brain weighed 955 g. Diffuse brain atrophy was most obvious in the bilateral frontotemporal regions. The atrophy of the left superior frontal and precentral gyri and bilateral basal ganglia was remarkable. Histologically, there was a marked loss of neurons with gliosis in the affected areas, where basophilic neuronal cytoplasmic inclusions were observed. The inclusions were immunoreactive for FUS, p62, and TATA-binding protein-associated factor 15 (TAF15), but not for phosphorylated tau, transactive response DNA-binding protein of 43 kDa (TDP-43), neurofilament protein, or Ewing sarcoma (EWS). From these pathological findings, this case was diagnosed as having BIBD as an FTLD-FUS variant. Spinal cord lower motor neurons were spared in number, similar to primary lateral sclerosis. Mutations in FUS were undetectable. Common background pathologies for CBS include corticobasal degeneration, Alzheimer's disease, PSP, FTLD with phosphorylated TDP-43 inclusions (FTLD-TDP), Pick's disease, Lewy body disease and CJD. However, FTLD-FUS (BIBD