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Sample records for autopsy

  1. Brain Autopsy

    MedlinePlus

    ... Monthly Donation Named Funds Planned Giving Gifts of Stock Business Partnerships Host an Event AFTD-Team Races ... family members to reach a closure after a long struggle. Brain autopsy is often done in conjunction ...

  2. Autopsy Renal Pathology.

    PubMed

    Paueksakon, Paisit; Fogo, Agnes B

    2014-09-01

    We provide an overview of assessment of the kidneys at autopsy, with special considerations for pediatric versus adult kidneys. We describe the approach to gross examination, tissue allocation when needed for additional studies of potential medical renal disease, the spectrum of congenital abnormalities of the kidneys and urinary tract, and approach to cystic diseases of the kidney. We also discuss common lesions seen at autopsy, including acute tubular injury, ischemic versus toxic contributions to this injury, interstitial nephritis, and common vascular diseases. Infections commonly involve the kidney at autopsy, and the key features and differential diagnoses are also discussed.

  3. 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

  4. Psychological Autopsies in Court.

    ERIC Educational Resources Information Center

    Litman, Robert E.

    1984-01-01

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

  5. Designing verbal autopsy studies

    PubMed Central

    2010-01-01

    Background Verbal autopsy analyses are widely used for estimating cause-specific mortality rates (CSMR) in the vast majority of the world without high-quality medical death registration. Verbal autopsies -- survey interviews with the caretakers of imminent decedents -- stand in for medical examinations or physical autopsies, which are infeasible or culturally prohibited. Methods and Findings We introduce methods, simulations, and interpretations that can improve the design of automated, data-derived estimates of CSMRs, building on a new approach by King and Lu (2008). Our results generate advice for choosing symptom questions and sample sizes that is easier to satisfy than existing practices. For example, most prior effort has been devoted to searching for symptoms with high sensitivity and specificity, which has rarely if ever succeeded with multiple causes of death. In contrast, our approach makes this search irrelevant because it can produce unbiased estimates even with symptoms that have very low sensitivity and specificity. In addition, the new method is optimized for survey questions caretakers can easily answer rather than questions physicians would ask themselves. We also offer an automated method of weeding out biased symptom questions and advice on how to choose the number of causes of death, symptom questions to ask, and observations to collect, among others. Conclusions With the advice offered here, researchers should be able to design verbal autopsy surveys and conduct analyses with greatly reduced statistical biases and research costs. PMID:20573233

  6. Autopsy approach to stroke.

    PubMed

    Love, Seth

    2011-02-01

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

  7. 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.

  8. 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

  9. Comparison of decomposition rates between autopsied and non-autopsied human remains.

    PubMed

    Bates, Lennon N; Wescott, Daniel J

    2016-04-01

    Penetrating trauma has been cited as a significant factor in the rate of decomposition. Therefore, penetrating trauma may have an effect on estimations of time-since-death in medicolegal investigations and on research examining decomposition rates and processes when autopsied human bodies are used. The goal of this study was to determine if there are differences in the rate of decomposition between autopsied and non-autopsied human remains in the same environment. The purpose is to shed light on how large incisions, such as those from a thorocoabdominal autopsy, effect time-since-death estimations and research on the rate of decomposition that use both autopsied and non-autopsied human remains. In this study, 59 non-autopsied and 24 autopsied bodies were studied. The number of accumulated degree days required to reach each decomposition stage was then compared between autopsied and non-autopsied remains. Additionally, both types of bodies were examined for seasonal differences in decomposition rates. As temperature affects the rate of decomposition, this study also compared the internal body temperatures of autopsied and non-autopsied remains to see if differences between the two may be leading to differential decomposition. For this portion of this study, eight non-autopsied and five autopsied bodies were investigated. Internal temperature was collected once a day for two weeks. The results showed that differences in the decomposition rate between autopsied and non-autopsied remains was not statistically significant, though the average ADD needed to reach each stage of decomposition was slightly lower for autopsied bodies than non-autopsied bodies. There was also no significant difference between autopsied and non-autopsied bodies in the rate of decomposition by season or in internal temperature. Therefore, this study suggests that it is unnecessary to separate autopsied and non-autopsied remains when studying gross stages of human decomposition in Central Texas

  10. 32 CFR 935.14 - Autopsies.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... WAKE ISLAND CODE Civil Administration Authority § 935.14 Autopsies. The medical officer on Wake Island, or any other qualified person under his supervision, may perform autopsies upon authorization of...

  11. 32 CFR 935.14 - Autopsies.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... WAKE ISLAND CODE Civil Administration Authority § 935.14 Autopsies. The medical officer on Wake Island, or any other qualified person under his supervision, may perform autopsies upon authorization of...

  12. 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…

  13. Attitudes about autopsy: implications for educational interventions.

    PubMed

    Connell, C M; Avey, H; Holmes, S B

    1994-10-01

    Although the role of autopsy in confirming diagnoses and advancing research is well documented, family members are inadequately informed about the procedure. The present study examined attitudes about autopsy among older adults. Focus group interviews were conducted with members of three caregiver support groups and two senior centers. Predominant themes included: benefits, barriers, religious views, and concerns about procedures. Results suggest the need to design educational interventions to: (a) involve family members in advance planning; (b) provide counseling regarding the purpose, process, and procedures of autopsy; and (c) facilitate communication skills and awareness of local autopsy services and policies among physicians.

  14. Autopsy

    MedlinePlus

    ... Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight ... Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight ...

  15. Fibrous Pleural Plaques Detected at Autopsy

    PubMed Central

    TÜRKMEN, Nursel; EREN, Bülent; GÜNDOĞMUŞ, Ümit Naci

    2014-01-01

    The reported case was a 84-year-old male, dead after a traffic accident. The death was considered to be suspicious by prosecutor and an autopsy was mandated. In macroscopic autopsy investigation left tibia, fibula and multiple rib fractures, widespread seborrheic keratoses, and hyperpigmented skin lesions were detected. In the left chest cavity blood content and white colored lesions spread on the left parietal pleura and chest surface of the thoracic diaphragm were observed. The histological examination of the pleural lesions revealed fibrotic hyalinized structures with calcified foci. Investigation of pleural plaques in forensic autopsy is important for scientific classification of this interesting entity. PMID:25705312

  16. 20 CFR 718.106 - Autopsy; biopsy.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... miner who died prior to March 31, 1980, an autopsy or biopsy report shall be considered even when the... concerning a miner who died prior to March 31, 1980, shall be accorded the appropriate weight in light of...

  17. Forensic autopsies in a naturalistic setting in Norway: autopsy rates and toxicological findings.

    PubMed

    Frost, Joachim; Slørdal, Lars; Vege, Åshild; Nordrum, Ivar S

    2012-11-30

    Autopsies can give valuable information about the cause of death, and represent an important tool for obtaining valid cause of death statistics. In particular, they may shed light on the circumstances of death in ambiguous and criminal cases. To address the need for information on current autopsy practices, forensic autopsy rates in two counties in Central Norway over the period 2007-2009 were assessed. To investigate toxicological findings that could possibly remain undisclosed without the performance of an autopsy, the impact of alcohol and drugs in forensic autopsy cases from this material was evaluated. The total forensic autopsy rate in this material was 3%. The forensic autopsy rates were low for natural deaths (1%), accidental falls (12%) and the heterogeneous category "other accidents" (21%), relatively high for accidental poisonings (84%), and less than adequate for road traffic accidents (57%). For suicides the forensic autopsy rate was 63%, and for recognized homicides 100%. The total forensic autopsy rate was higher for men than for women (5% vs. 2%), and decreased with age, being 38% in the age group <30 years, 23% in the age group 30-59 years, and 1% in the age group >59 years. Despite that Norwegian legislation and regulations regarding forensic autopsy requests are national, the forensic autopsy rates were generally lower in the county of Nord-Trøndelag than in Sør-Trøndelag, with most striking differences in suicide deaths (11% vs. 91%) and road traffic accidents (46% vs. 67%). This illustrates how autopsy rates, and possibly cause of death registries, might be susceptible to the influence of regional variations in law enforcement, with possible consequences for the quality and validity of cause of death statistics. Of the forensic autopsy cases where toxicological analysis was performed (361 of 364 cases) a total of 71% had positive toxicology results; 12% were positive for alcohol only, 44% were positive for drugs only, and 15% were positive

  18. VIRTOPSY - the Swiss virtual autopsy approach.

    PubMed

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

    2007-03-01

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

  19. The response of relatives to medicolegal investigations and forensic autopsy.

    PubMed

    Plattner, Thomas; Scheurer, Eva; Zollinger, Ulrich

    2002-12-01

    Relatives of deceased persons, on whose body a forensic autopsy had been performed at the Institute of Forensic Science, Bern, Switzerland, were interrogated by a questionnaire. The aim was to investigate the attitude of relatives toward medicolegal investigation procedures in general and toward forensic autopsy in particular. A great majority of the relatives showed a positive or indifferent attitude toward a forensic autopsy. They showed a great interest in autopsy results and wished to be informed. It was concluded that information given before the autopsy is important for better understanding and can, if properly given, improve the relatives' acceptance and collaboration regarding forensic investigations. By contrast, a lack of information before the autopsy and about the autopsy results can cause further suffering on behalf of the bereaved. A forensic autopsy can be of great benefit for relatives and can help them to cope with a tragic loss.

  20. 77 FR 38179 - Autopsies at VA Expense

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-27

    ... clarifies that the authority to order an autopsy includes transporting the body at VA's expense to the place... dies while receiving fee-basis care under Sec. 17.52 and to pay the expense of transporting the body... substantive changes. We made a couple of nonsubstantive edits to proposed Sec. 17.170(a)(1). Effect...

  1. Incidence of systemic mycoses in autopsy material.

    PubMed

    Koch, S; Höhne, F-M; Tietz, H-J

    2004-02-01

    The incidence of systemic mycoses was investigated in the autopsy material of the Institute of Pathology of the Humaine Hospital in Bad Saarow, Germany. This hospital provides qualified standard care in east Brandenburg with a wide spectrum of medical disciplines caring for patients with acute medical conditions as well as oncological cases (660 beds). Between 1973 and 2001, 47 systemic mycoses were diagnosed in 4813 autopsies of deceased adults, corresponding to 0.98%. During the period of investigation, both the care provided by the hospital and the organization of the health service changed. The autopsy frequency fell from about 80% (1973-1991) to about 28% (1992-2001). This is thus still far higher than the average of about 3% assumed for the Federal Republic of Germany. Although the incidence of systemic mycoses increased during the entire 29-year period of investigation, the number of cases in whom this was the immediate cause of death decreased. Whereas candidoses predominated from 1973 to 1991, a shift in favor of aspergilloses was noticed in the period from 1992 to 2001. Systemic mycosis was diagnosed intravitally in only three of 47 cases. The present study therefore underscores the significance of clinical autopsy as a diagnostic method and means of medical quality control.

  2. Autopsy after death due to extreme prematurity.

    PubMed

    Elder, D E; Zuccollo, J M

    2005-05-01

    Autopsy reports for 29 very preterm infants dying at <28 days of age were reviewed. New findings were discovered in 79% and resulted in a significant change in diagnoses in 28%. Iatrogenic lesions were identified in 41% of cases and were the main cause of death in 14%.

  3. Attitudes about Autopsy: Implications for Educational Interventions.

    ERIC Educational Resources Information Center

    Connell, Cathleen M.; And Others

    1994-01-01

    Examined attitudes about autopsy by conducting focus group interviews with caregiver support group and senior center members. Themes included benefits, barriers, religious views, and concerns about procedures. Results suggest need for educational interventions to involve family in advance planning; provide counseling regarding purpose, process,…

  4. 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.

  5. An autopsy case of Erysipelothrix rhusiopathiae endocarditis.

    PubMed

    Yamamoto, Yoshihiro; Shioshita, Kei; Takazono, Takahiro; Seki, Masafumi; Izumikawa, Koichi; Kakeya, Hiroshi; Yanagihara, Katsunori; Tashiro, Takayoshi; Otsuka, Yoshihito; Ohkusu, Kiyofumi; Kohno, Shigeru

    2008-01-01

    A 58-year-old man was admitted to our hospital with fever. The vegetation was confirmed by echocardiography on the tricuspid valve and Erysipelothrix rhusiopathiae was isolated by blood culture. The patient died due to heart failure, and tricuspid valve vegetation was confirmed on autopsy and the sample of Gram's staining showed gram-positive microcolonies. Although about 60 cases of E. rhusiopathiae endocarditis have been reported, Japanese cases are extremely rare.

  6. Attitudes Toward the Autopsy – An 8-State Survey

    PubMed Central

    Nemetz, Peter N.; Tangalos, Eric; Sands, Laura P.; Fisher, William P.; Newman, William P.; Burton, Elizabeth C.

    2006-01-01

    Context National autopsy rates have declined for several decades, and the reasons for such decline remain contentious. Objective To elicit the opinions of one group of crucial decision makers as to the reasons for this decline and possible modes of reversal. Design A 2-part survey, composed of multiple choice questions and questions requesting specific data on autopsy rates and costs. Setting Illinois, Iowa, Louisiana, Minnesota, Nebraska, North Dakota, South Dakota, and Wisconsin. Participants Hospital administrators within the 8 states. Main Outcome Measures Six-point survey scale relating to reasons for autopsy decline and possible remedial measures, as well as estimates of autopsy rates and costs. Results The response rate was 43% and the median autopsy rate was 2.4% (mean 6.1%). The median cost of autopsy was estimated at $852 (mean $1275). Larger hospitals were associated with higher autopsy rates than smaller hospitals (9.6% vs 4.0%), and teaching hospitals had a significantly higher autopsy rate than nonteaching institutions (11.4% vs 3.8%). Autopsy rates also varied by type of hospital control, with federal government hospitals having the highest autopsy rate at 15.1%. Sixty-six percent of all respondents agreed that current autopsy rates were adequate. Of the respondents, the highest percent (86%) agreed that improved diagnostics contributed to the decline in autopsies, and the highest percent (78%) agreed that direct payment to pathologists for autopsies under the physician fee schedule might lead to an increase in autopsies. Conclusions Our data support the conclusion that the decline in autopsy performance is multifactorial, although the variable that dominates in this analysis is the contentious perception that improved diagnostic technology renders the autopsy redundant. The rate of autopsy is conditional, at least in part, on individual hospital characteristics such as large hospital size, teaching status, and federal ownership. Three underlying

  7. A survey of general practitioners' views on autopsy reports.

    PubMed Central

    Karunaratne, S; Benbow, E W

    1997-01-01

    AIMS: To study the views of general practitioners on the quality and utility of autopsy reports, and on autopsies in general. METHODS: For a period of six months, a questionnaire was enclosed with each autopsy report sent to a general practitioner from the mortuary at Manchester Royal Infirmary. RESULTS: Most (93.3%) general practitioners found the autopsy report useful, and many (66.7%) thought the bereaved relatives would do so too. However, only a minority (25.2%) would discuss the report with the relatives. A considerable proportion (20.0%) found the cause of death surprising, and a significant number (10.4%) felt the report would modify their future clinical practice. There was approval of autopsies in general, with most (88.6%) agreeing that autopsies reveal lesions not detected in life, and many (74.4%) indicating that loss of the autopsy would impair severely the monitoring of clinical standards. CONCLUSIONS: General practitioners appreciate autopsy reports, which may have a significant impact on clinical practice. Autopsy reports provide both case audit and information for relatives. PMID:9306932

  8. 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.

  9. 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

  10. 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.

  11. Molecular autopsy in victims of inherited arrhythmias.

    PubMed

    Semsarian, Christopher; Ingles, Jodie

    2016-10-01

    Sudden cardiac death (SCD) is a rare but devastating complication 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, inherited cardiac disorders comprise a substantial proportion of SCD cases aged less than 40 years. Inherited cardiac disorders include primary inherited arrhythmogenic disorders such as familial long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and inherited cardiomyopathies, most commonly hypertrophic cardiomyopathy (HCM). In up to 40% of young SCD victims (defined as 1-40 years old, excluding sudden unexplained death in infancy from 0 to 1 years, referred to as SIDS), no cause of death is identified at postmortem [so-called "autopsy negative" or "sudden arrhythmic death syndrome" (SADS)]. Management of families following a SCD includes the identification of the cause of death, based either on premorbid clinical details or the pathological findings at the postmortem. When no cause of death is identified, genetic testing of DNA extracted from postmortem tissue (the molecular autopsy) may identify a cause of death in up to 30% of SADS cases. Targeted clinical testing in a specialized multidisciplinary clinic in surviving family members combined with the results from genetic testing, provide the optimal setting for the identification of relatives who may be at risk of having the same inherited heart disease and are therefore also predisposed to an increased risk of SCD.

  12. [Autopsies as an important indicator for quality control].

    PubMed

    van den Tweel, J G

    1999-11-20

    The decreasing number of autopsies, in the Netherlands as well, is deplorable because with it an important instrument of medical quality control is likely to disappear. For this not only the relatives, but also the attending physicians and the pathologists are to blame. To turn the tide we need some drastic changes in our attitude towards autopsies. The families should known that an autopsy is a right they have in order to check the quality of diagnosis and treatment of their beloved, it is not a favour towards the physician. A physician who does not see a reason for autopsy, should explain that to the family. Pathologists should think about and realize a subspecialty of autopsy pathology with a thorough training in pathophysiology and intensive care medicine. Autopsy reports should be of the highest quality and reach the physician within a few weeks. A required autopsy percentage should be introduced into the certification process of medical specialists and hospitals and the possibility of Continuous Medical Education credit points for physicians with a certain autopsy percentage should be considered.

  13. Plutonium and Cs-137 in autopsy tissues in Great Britain.

    PubMed

    Popplewell, D S; Ham, G J; Dodd, N J; Shuttler, S D

    1988-03-01

    Tissues removed at autopsy from members of the general public contain significantly higher concentrations of plutonium and 137Cs in west Cumbrians than in people from three other regions of Great Britain. Several autopsy cases from Cumbria showed unusually high values of plutonium. Subsequently it was found that the subjects had been former employees of British Nuclear Fuels.

  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.

  15. [Multiple urologic tumors in autopsy material].

    PubMed

    Tiszlavicz, L; Szalay, I

    1993-03-14

    In autopsy material of the Department of Pathology at the Albert Szent-Györgyi Medical University in 16.8% of kidney cancers, in 12.5% of urinary bladder cancers and in 21.8% of prostatic cancers were second primary malignant tumours observed in the urinary system or in other organs. The cause of the relatively frequent tumour-associations can partly be explained with the high average age (72 years). The uropoetic cancers were in association with lung cancers (role of tobacco smoking?), gastrointestinal tumours (role of genetic or dietary factors?); and the prostatic carcinomas with urinary bladder cancer and hematologic malignancies. In our material testicular cancers were never associated with other malignancies.

  16. Paraneoplastic chorea: case study with autopsy confirmation.

    PubMed Central

    Tremont-Lukats, Ivo W.; Fuller, Gregory N.; Ribalta, Teresa; Giglio, Pierre; Groves, Morris D.

    2002-01-01

    A 67-year-old man presented with a 7-month history of insidiously progressive chorea, ataxia, and vertigo. Neurologic examination revealed deficits referable to the basal nuclei, cerebellar vermis, and vestibular nuclei. Small-cell lung cancer was diagnosed by fine-needle biopsy of a parahilar mass. After chemotherapy, the patient's chorea worsened. Anti-Hu antibodies were present in serum and cerebrospinal fluid. Microscopic examination of the brain at autopsy revealed diffuse perivascular lymphocytic infiltrates, microglial activation, and neuronophagia throughout the neuraxis, including the brainstem, cerebellum, lenticular nuclei, striatum, and cerebral cortex. Prominent loss of Purkinje cells was seen in the cerebellar vermis and hemispheres to a lesser degree. Chorea is extremely rare as a paraneoplastic manifestation of cancer. The florid presentation and the positive findings contrasted with an unremarkable MRI of the brain. This case illustrates the preeminence of symptoms and signs over negative MRI findings in paraneoplastic encephalitis. PMID:12084350

  17. Use of Smartphone for Verbal Autopsy.

    PubMed

    Zhao, Yi; Joshi, Rohina; Rampatige, Rasika; Sun, Jixin; Huang, Liping; Chen, Shu; Wu, Ruijun; Neal, Bruce; Lopez, Alan D; Stewart, Andrea L; Serina, Peter T; Li, Cong; Zhang, Jing; Zhang, Jianxin; Zhang, Yuhong; Yan, Lijing L

    2016-10-01

    Traditionally, verbal autopsies (VA) are collected on paper-based questionnaires and reviewed by physicians for cause of death assignment, it is resource intensive and time consuming. The Population Health Metrics Research Consortium VA questionnaires was made available on an Android-based application and cause of death was derived using the Tariff method. Over one year, all adult deaths occurring in 48 villages in 4 counties were identified and a VA interview was conducted using the smartphone VA application. A total of 507 adult deaths were recorded and VA interviews were conducted. Cardiovascular disease was the leading cause of death (35.3%) followed by injury (14.6%) and neoplasms (13.5%). The total cost of the pilot study was USD28 835 (USD0.42 per capita). The interviewers found use of smartphones to conduct interviews to be easier. The study showed that using a smartphone application for VA interviews was feasible for implementation in rural China.

  18. [Body's integumentary restoration after autopsy: legislative, technical and ethical issues].

    PubMed

    Delannoy, Yann; Becart-Robert, Anne; Houssaye, Cédric; Pollard, Jocelyn; Cornez, Raphaël; Tournel, Gilles; Gosset, Didier; Hedouin, Valéry

    2013-02-01

    In France, families of the deceased raised concerns as regards to the conditions of restoration of body. If scientists hospital autopsies are organized by the Bioethics Law of August 6, 2004, the forensic autopsies were so far not provided with such a legal framework. The legislator has proposed the creation of a new chapter in the Code of Criminal Procedure institutionalizing forensic activities. This legislative evolution allows the harmonization of practices; forensic pathologists must be involved in these changes by bringing their scientific expertise, notably through improving their autopsy techniques.

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

    Mohammed, Madadin; Kharoshah, Magdy A

    2014-03-01

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

  1. Detection of occult disease in tissue donors by routine autopsy.

    PubMed

    Otero, J; Fresno, M F; Escudero, D; Seco, M; González, M; Peces, R

    1998-01-01

    The transmission of infectious and neoplastic diseases is a potential risk of tissue allografting. In this study, we analyzed the occurrence of occult disease in tissue donors as detected by standard screening and autopsy. Whereas 18% of the potential donors initially evaluated were eliminated on the basis of their medical and social histories, laboratory screening and autopsy revealed that an additional 9% of tissue donors had undetected, transmissible disease that prohibited tissue donation. This report emphasizes once again the risk of occult disease being transplanted with grafts and the need for autopsy to reduce the likelihood of this occurring. If donor selection, appropriate screening tests, and autopsy are carefully carried out, the risk of transmitting diseases from tissue allografts can be kept to a minimum.

  2. 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

  3. Accuracy of cause of death determination without forensic autopsy examination.

    PubMed

    Nashelsky, Marcus B; Lawrence, Christopher H

    2003-12-01

    Medical examiners and coroners commonly determine cause and manner of death without an autopsy examination. Some death certificates generated in this way may not state the correct cause and manner of death. From the case files of the Department of Forensic Medicine in Sydney, Australia, the authors retrospectively reviewed investigative information of all cases in a 6-month period that were initially considered natural deaths (429). The authors, blinded to autopsy results, accepted 261 cases as appropriate for certification without autopsy and assigned a cause of death to each. Per standard local practice, all cases had been autopsied. The actual causes of death as determined by autopsy were then revealed and compared with the presumed causes of death. Most presumed and actual causes of death were cardiovascular (94% and 80%, respectively). The majority of presumed causes of death were listed as ASCVD as the cases lacked features of a more specific cardiovascular process. A large majority of cases had a presumed cause of death of ischemic heart disease based on individual case details. The actual causes of death demonstrated a large breadth of cardiovascular and noncardiovascular disease processes, even though ischemic heart disease accounted for 62% of deaths. The presumed cause of death was completely wrong in 28% of cases. A nonnatural manner of death was present in 3% of cases. This study demonstrates that experienced forensic pathologists may generate erroneous death certificates for cases that are not autopsied.

  4. 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.

  5. [Epidemiology of Visceral Mycoses in Autopsy Cases in 2011].

    PubMed

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

    2015-01-01

    To identify recent trends in the frequency of mycoses in autopsy cases, we performed an epidemiological analysis using the data reported in the "Annual Report of Autopsy Cases in Japan" from 2011. 12,339 cases were autopsied, of which 608 (4.9 %) were found to have fungal infections. Of these, 411 cases (67.6 %) were male, the median age was 67, and 353 cases were severe (58.1 %). Aspergillus spp. was the most predominant causative agent among those infected with one pathogen. These data corroborate our previous data from reports in 2007 and 2009. For the first time since 1989, we observed a case of mycoses caused by Exophiala spp. with adult T cell leukemia and lymphoma. The types of underlying disease were also typical of that in our previous analysis in 2009. These included solid cancers in 124 cases (20.4 %), leukemia in 83 cases (13.7 %), bacterial infections such as pneumonia 69 cases (11.3 %) and malignant lymphoma in 66 cases (10.9 %). In 2011, the number of mycoses following solid organ transplantation totaled 12 cases and was the most numerous since 2005. A limitation of this study may be that the epidemiology of autopsied cases includes the more severe end of the fungal infection spectrum, and selection bias could not be ruled out. Nonetheless, this epidemiological analysis of autopsied cases with fungal infection provides a strong incentive to intensify and improve efforts in diagnosing and treating visceral mycosis.

  6. Agenesis of the corpus callosum. An autopsy study in fetuses.

    PubMed

    Kidron, Debora; Shapira, Daniel; Ben Sira, Liat; Malinger, Gustavo; Lev, Dorit; Cioca, Andreea; Sharony, Reuven; Lerman Sagie, Tally

    2016-02-01

    Agenesis of the corpus callosum is currently diagnosed prenatally with ultrasound and MRI. While the diagnostic aspects of callosal defects are widely addressed, anatomo-histological data from fetal autopsies are sparse. Callosal defects were present in 50 fetal autopsies. Four distinct groups of complete, partial, hypoplastic, and mixed defects were determined by the gross and histologic details of the corpus callosum. These details helped to rule out other midline defects such as holoprosencephaly. Additional autopsy findings enabled specific diagnoses and suggested etiopathogeneses. Hypoplastic and mixed defects were associated with more abnormalities of the cerebral hemispheres and internal organs. The four groups did not differ according to gender, external dysmorphism, or cerebellar and brainstem anomalies. Defects were classified as syndromic (68 %), encephaloclastic (8 %), undetermined (14 %), or isolated (10 %) based on the autopsy findings. Isolated agenesis of the corpus callosum was diagnosed in only 10 % of the cases in this series, compared to higher numbers diagnosed by prenatal ultrasonography and MRI. Therefore, the autopsy, through its detailed, careful evaluation of external, as well as gross and histological internal features, can elucidate the etiopathogenesis of agenesis of the corpus callosum and suggest specific diagnoses which cannot be ascertained by prenatal imaging.

  7. [Medico-legal autopsy--selected legal issues: the autopsy protocol].

    PubMed

    Gaszczyk-Ozarowski, Zbigniew; Chowaniec, Czesław

    2010-01-01

    The majority of experts in the field of forensic medicine maintain that the minutes of the medicolegal autopsy should be taken by the forensic pathologist. The authors argue that it is the public prosecutor who is obliged to draw up the minutes, whereas the forensic pathologist issues the expert opinion. To support their stance, the authors make frequent references to several provisions of the Criminal Procedure Code of 1997. The authors also imply that due to organizational reasons and the ratio legis of the aforementioned code, the forensic pathologist should not be assigned the role of the minutes-taker, despite the lack of a specific exclusion rule governing such a case. Possible consequences caused by the lack of the properly drawn up minutes are briefly discussed as well.

  8. Problems in the analysis of cadmium in autopsied tissues

    SciTech Connect

    Koizumi, Naoko ); Hatayama, Fumikazu; Sumino, Kimiaki )

    1994-02-01

    A comparison was made between the concentrations of Cd, Zn, Cu, and Fe in the organs at autopsy and after fixation in formalin for anatomicopathological examination. The concentrations of all the metals were lower in the formalin-fixed organs. In particular, the residual rates of Cd in the renal cortex and medulla were 2.3 and 6.1% of those for the fresh organs, respectively. The Cd concentration in the blood collected at autopsy was several hundred times as high as the value measured before death and failed to be an indicator of exposure of Cd. This phenomenon is specific to Cd and is not found with other metals. In determining Cd in the organs collected at autopsy, it is important to avoid contamination with blood, remove water around the organs quickly, and preserve the organs in sealed polyethylene bags. 12 refs., 1 fig., 5 tabs.

  9. Clinical diagnosis versus autopsy findings in polytrauma fatalities

    PubMed Central

    2010-01-01

    Objectives The aim of the study was to determine if differences in clinical diagnosis versus autopsy findings concerning the cause of death in polytrauma fatalities would be detected in 19 cases of fatal polytrauma from a Level 1 trauma centre. Methods Clinical diagnoses determining the cause of death in 19 cases of fatal polytrauma (2007 - 2008) from a Level 1 trauma centre were correlated with autopsy findings. Results In 13 cases (68%), the clinical cause of death and the cause of death as determined by autopsy were congruent. Marginal differences occurred in three (16%) patients while obvious differences in interpreting the cause of death were found in another three (16%) cases. Five fatalities (three with obvious differences and two with marginal differences) were remarked as early death (1-4 h after trauma) and one fatality with marginal differences as late death (>1 week after trauma). Obvious and marginal discrepancies mostly occurred in the early phase of treatment, especially when severely injured patients were admitted to the emergency room undergoing continued cardiopulmonary resuscitation, i. e. limiting diagnostic procedures, and thus the clinical cause of death was essentially determined by basic emergency diagnostics. Conclusions Autopsy as golden standard to define the cause of death in fatal polytrauma varies from the clinical point of view, depending on the patient's pre-existing condition, mechanism of polytrauma, necessity of traumatic cardiopulmonary resuscitation, survival time, and thus the possibility to perform emergency diagnostics. An autopsy should be performed at least in cases of early fatal polytrauma to help establishing the definite cause of death. Moreover, autopsy data should be included in trauma registries as a quality assessment tool. PMID:20977732

  10. A safer method for body restoration following autopsy.

    PubMed

    Duflou, Johan; McNamara, Bradley; Cluney, Robert

    2014-01-01

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

  11. [Autopsy room and the July 30th 2004 memorandum].

    PubMed

    Canas, Frédéric; Guillou, Pierre-José; Lorin de la Grandmaison, Geoffroy; Diebold, Marie-Danièle; Patey, Martine; Bureau-Chalot, Florence; Bajolet, Odile; Jeunehomme, Gérard; Bernard, Mary-Hélène; Durigon, Michel; Pluot, Michel

    2005-06-01

    With the July 30th 2004 memorandum, for the first time a text is specifically dedicated to the architecture of the autopsy room. This memorandum reaffirms certain technical specifications stated in the May 7th 2001 decree applicable to hospital mortuaries. It supplements or modifies certain elements, particularly liquid waste processing, which will require new arrangements in death chambers and new expenditures for hospital administrations. It includes the principle of precaution and requires a new approach to handling human corpses in the autopsy room.

  12. Relatives' attitudes towards medico-legal investigation and forensic autopsy: a study from South Delhi.

    PubMed

    Behera, C; Rautji, R; Dogra, T D

    2008-04-01

    Relatives of deceased persons on whose bodies a medico-legal autopsy had been performed at the All India Institute of Medical Sciences, New Delhi, India were personally asked to complete a questionnaire. The aim of study was to determine surviving family members' attitudes towards medico-legal investigation and forensic autopsy. The majority of the relatives showed a positive attitude towards forensic autopsy but were not aware of the detailed procedure of the autopsy. They wanted sufficient information to be provided before the autopsy. They showed a great interest in autopsy results i.e. the cause of death. It was concluded that sufficient relevant explanations given before the autopsy improves the relatives' acceptance and helps alleviate the suffering of the bereaved. The experience and opinions of relatives may help an autopsy surgeon in more effective management of medico-legal cases.

  13. 28 CFR 549.80 - Authority to conduct autopsies.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... coroner or from the inmate's next-of-kin) is required. A decision on whether to order an autopsy is... person (e.g., coroner, or next-of-kin, or the decedent's consent in the case of tissue removed for...-of-kin, the following message is to be included in the telegram notifying the family or...

  14. Foetal Autopsy-Categories and Causes of Death

    PubMed Central

    Sherwani, Rana; Khan, Tamkin; Zaheer, Sufian

    2014-01-01

    Introduction: Intrauterine death(IUD)/ Stillbirth forms a major part of perinatal mortality which thereby is a good indicator of pregnancy wastage as well as quality of healthcare available. The key objectives of autopsy examination are to know the cause(s) of death, elucidation of pathogenic mechanism and quality control of clinical management. The aim of this study was to identify the prevalent causes of IUD, thereby taking appropriate measures to prevent them and decrease the perinatal mortality rate. Materials and Methods: The study included 14 cases of IUD received for autopsy in the Department of Pathology over a period of five years. Autopsies were performed as per standard protocol and included full anthropometric profile, external examination, gross and microscopic evaluation of different organs and placenta. Results: Total number of 14 fetal autopsies were performed over a period of 5 years. The causes were broadly classified as fetal, maternal and placental. Placental causes were seen in majority of cases (48.57%) followed by fetal (35.72%) and then maternal (21.42). Most prevalent cause of death was congenital anomalies (28.6%) followed by placental insufficiency (21.4%) and chorioamnionitis (14.2%). Conclusion: Determination of causes of fetal death would prove beneficial to the clinicians and parents for better management and care in future pregnancies as well as in genetic counseling. PMID:25478345

  15. 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…

  16. 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…

  17. 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…

  18. Medical Students' Attitudes Toward the Autopsy as an Educational Tool.

    ERIC Educational Resources Information Center

    Tazelaar, Henry D.; And Others

    1987-01-01

    A survey of 9 post-sophomore pathology program fellows concerning their attitudes toward autopsy as an educational tool found they perceived the procedures and report-writing to (1) teach many skills highly relevant to the practice of clinical medicine and (2) be a useful investment of time and effort. (MSE)

  19. [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.

  20. Comorbidity in Dementia: Update of An Ongoing Autopsy Study

    PubMed Central

    Magaki, Shino; Yong, William H.; Khanlou, Negar; Tung, Spencer; Vinters, Harry V.

    2014-01-01

    OBJECTIVES To examine systemic and central nervous system (CNS) comorbidities of patients with dementia evaluated during general autopsy. DESIGN Retrospective cohort study. SETTING A large tertiary academic medical center in Los Angeles, California. PARTICIPANTS A cohort of 86 participants with clinically and neuropathologically diagnosed dementia who received complete autopsies and 132 participants with dementia who received partial (brain only) autopsies. MEASUREMENTS The causes of death as well as systemic and CNS comorbidities were obtained from autopsy reports and clinical information as available from the medical records. Findings were tabulated with respect to type of dementia, semiquantitative assessment of the severity of cerebral amyloid angiopathy, semiquantitative assessment of the severity of cerebrovascular disease, and evidence of ischemic damage in the brain. RESULTS Out of a total of 218 subjects with dementia, 175 (80.3%) had Alzheimer’s disease (AD) either in isolation or in combination with other lesions that might contribute to cognitive impairment, such as cerebrovascular disease and diffuse Lewy body disease (DLBD), 14 (6.4%) had frontotemporal dementia (FTD), and 7 (3.2%) had isolated DLBD. The most common cause of death among demented patients was pneumonia (57 cases, 66.3%) followed by cardiovascular disease (14 cases, 16.3%). Eighteen subjects (20.9%) had lung disease and 16 (18.6%) had evidence of old or recent myocardial infarct. Clinically undiagnosed neoplasms included colonic adenocarcinoma, metastatic pulmonary neuroendocrine carcinoma, meningioma, and Schwannoma. CONCLUSION Significant comorbidities were discovered at autopsy in patients with dementia. Understanding the causes of death and associated comorbidities in patients with various subtypes of dementia is important in the assessment of end of life care in these subjects. PMID:25039832

  1. 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.

  2. [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

  3. Autopsy practices at CERAD and Alzheimer disease center sites: a survey of neuropathologists.

    PubMed

    Cochran, E J; Gostanian, O M; Mirra, S S

    1995-01-01

    A questionnaire, collecting information on methods used at neuropathology core facilities for handling of brain autopsies on dementia and control subjects, was sent to 29 CERAD (Consortium to Establish a Registry for Alzheimer's Disease) and/or Alzheimer's Disease Center (ADC) sites. Neuropathologists shared their successes and concerns in response to questions regarding administrative, technical, and neuropathological procedures for brain autopsies and tissue banking. Adequacy of fiscal support and staff, scarcity of control cases, and logistical aspects of autopsy coordination emerged as common problems. Successful strategies included the designation of dedicated autopsy coordinators, enhanced relationships with community hospital pathologists and funeral homes, and increased multilevel educational efforts on the importance of the autopsy.

  4. 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.

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

    PubMed

    Morgan, Matthew; Schwartz, Liliana; Duflou, Johan

    2015-03-01

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

  6. 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.

  7. Heme oxygenase-1 deficiency: the first autopsy case.

    PubMed

    Kawashima, Atsuhiro; Oda, Yoshio; Yachie, Akihiro; Koizumi, Shoichi; Nakanishi, Isao

    2002-01-01

    This article describes the first autopsy case of heme oxygenase (HO)-1 deficiency. A 6-year-old boy who presented with growth retardation; anemia; leukocytosis; thrombocytosis; coagulation abnormality; elevated levels of haptoglobin, ferritin, and heme in serum; a low serum bilirubin concentration; and hyperlipidemia was diagnosed as HO-1 deficient by gene analysis several months before death. Autopsy showed amyloid deposits in the liver and adrenal glands and mesangioproliferative glomerular changes in kidneys, in addition to an irregular distribution of foamy macrophages with iron pigments. Fatty streaks and fibrous plaques were noted in the aorta. Compared with HO-1--targeted mice, the present case seems to more severely involve endothelial cells and the reticuloendothelial system, resulting in intravascular hemolysis, disseminated intravascular coagulation, and amyloidosis with a short survival. This contrasts to the predominant iron metabolic disorders of HO-1--targeted mice with a long survival.

  8. Recognition of skeletal fractures in infants: an autopsy technique.

    PubMed

    Love, Jennifer C; Sanchez, Luis A

    2009-11-01

    Complete recognition and documentation of injury pattern is crucial in the diagnosis of child abuse. Skeletal fractures regarded as highly specific to nonaccidental injury in infants include posterior rib, scapular, metaphyseal, and spinous process fractures. These injuries are often occult, especially when acute, to standard radiologic and autopsy procedures. The presented autopsy technique requires incising and reflecting skeletal muscles to expose the bones and costal osseous joints in situ, increasing the opportunity to recognize skeletal injury. Fractured or atypical appearing bones are removed and processed for complete evaluation. The bones are processed by macerating the soft tissue in a water soap bath at an elevated temperature. To aid in reconstruction of the decedent, long bones are replaced with wooden dowels and the chest cavity is packed with the organ bag. The technique is invasive and recommended for cases in which the pathologist has reasonable suspicion of acute or remote trauma.

  9. Pheochromocytoma Multisystem Crisis Behaving Like Interstitial Pneumonia: An Autopsy Case

    PubMed Central

    Nomoto, Yohta; Kawano, Kiyoshi; Fujisawa, Naoki; Yoshida, Keiko; Yamashita, Tomoko; Makita, Naoki; Takeshita, Hiroaki; Kamimori, Kimio; Yanagi, Shiro; Yoshiyama, Minoru

    2017-01-01

    Pheochromocytoma multisystem crisis is a rare and life-threatening disease that is associated with numerous symptoms and which is also difficult to diagnose. We herein report an autopsy case of a 61-year-old man who died due to pheochromocytoma multisystem crisis. The patient complained of vomiting and breathlessness. Computed tomography showed a shadow-like region with a similar appearance to interstitial pneumonia. The patient was diagnosed with takotsubo cardiomyopathy induced by severe lung disease based on the results of echocardiography and coronary angiography. The patient was treated for interstitial pneumonia. However, his condition rapidly deteriorated and he died 6 hours after arrival. We were later informed of his extremely high catecholamine serum levels. We found pheochromocytoma with hemorrhage at autopsy. The patient's lungs showed acute passive congestion with edema and extravasation. PMID:28090043

  10. Is it possible to improve the autopsy rate?

    PubMed

    Djaldetti, M; Hart, J; Yarmolovsky, A; Zeidman, A; Floru, S; Gardyn, J; Gal, R; Ben-Dayan, D; Mittelman, M

    1995-07-01

    To improve the autopsy rate in a department of internal medicine, the method reported by Clayton and Sivak in 1992 was simplified and applied for a 12 month period, from January through December 1993. The basic principle of this method is involvement of the senior resident staff and supervision of the project by the head and deputy head of the department, on a daily basis. A simple form was designed for this purpose and was completed for each case. Results were compared with those between the same months in 1992. An increase in the autopsy rate from 1.8% in 1992 to 26.7% during the trial period in 1993 was noted.

  11. An autopsy case of classical Pelizaeus-Merzbacher's disease.

    PubMed

    Konishi, Y; Kamoshita, S

    1975-01-01

    A girl aged 8 years and 10 months at death had shown signs of a slowly progressive neurological disease with onset in early infancy. The main clinical features were nystagmus, spastic paraplegia, amd mental deterioration. Pathological examination of the brain showed severe demyelination with perivascular preservation of mylein islands, presenting a tigroid pattern. The patient is the second case of classical Pelizaeus-Merzbacher's disease in Japan proven by autopsy.

  12. Autopsy observations in lethal short-rib polydactyly syndromes.

    PubMed

    Okiro, Patricia; Wainwright, Helen; Spranger, Jürgen; Beighton, Peter

    2015-01-01

    The short rib-polydactyly syndromes are a heterogeneous group of lethal autosomal recessive disorders (SRP I-IV), which result from cellular ciliary dysfunction during embryogenesis. Diagnosis is conventionally based on radiographic imaging. Since 1976, postmortem investigations of 5 affected fetuses or stillbirths have been undertaken and the visceral abnormalities have been documented. These anomalies are discussed in the context of prenatal differential diagnosis and prognostication following imaging in pregnancy and at autopsy following miscarriage or stillbirth.

  13. 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.

  14. 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

  15. Occupational attainment influences survival in autopsy-confirmed frontotemporal degeneration

    PubMed Central

    Zee, Jarcy; Xie, Sharon X.; McMillan, Corey T.; Rascovsky, Katya; Irwin, David J.; Kolanowski, Ann; Grossman, Murray

    2015-01-01

    Objective: To examine the influence of occupational attainment and education on survival in autopsy-confirmed cases of frontotemporal lobar degeneration (FTLD) and Alzheimer disease (AD). Methods: We performed a retrospective chart review of 83 demographically matched, autopsy-confirmed FTLD (n = 34) and AD (n = 49) cases. Each patient's primary occupation was classified and ranked. Level of education was recorded in years. Survival was defined as time from symptom onset until death. Linear regression was used to test for associations among occupational attainment, education, and patient survival. Results: Median survival was 81 months for FTLD and 95 months for AD. Years of education and occupational attainment were similar for both groups. We found that higher occupational attainment was associated with longer survival in FTLD but not AD. Conclusions: Our findings suggest that higher occupational attainment is associated with longer survival in autopsy-confirmed FTLD. The identification of protective factors associated with FTLD survival has important implications for estimates of prognosis and longitudinal studies such as treatment trials. PMID:25904687

  16. Prospective Collection of Tissue Samples at Autopsy in Children with Diffuse Intrinsic Pontine Glioma

    PubMed Central

    Broniscer, Alberto; Baker, Justin N.; Baker, Suzanne J.; Chi, Susan N.; Geyer, J. Russell; Morris, E. Brannon; Gajjar, Amar

    2010-01-01

    BACKGROUND Brain tissue obtained at autopsy has been used in research for non-oncological disorders. However, this tool has never been systematically used in large investigational studies for cancer. We conducted a prospective, multicenter study to assess the feasibility of tissue collection at autopsy and its suitability for molecular analyses in children with diffuse intrinsic pontine glioma. METHODS Tumor tissue was collected at diagnosis, if clinically indicated, or at autopsy. Normal brain tissue was also collected at autopsy. The integrity of DNA and RNA was evaluated in all samples. Logistical data about autopsies were recorded. The feasibility of tissue collection at autopsy was assessed for patients treated at a single institution over a 43-month period. RESULTS Tumor samples were collected at diagnosis (n=3) or at autopsy (n=38) at 29 centers across the US; samples were obtained at diagnosis and autopsy in two cases. The median interval from death to autopsy was 7.7 hours. DNA and RNA with minimal or partial degradation, which were suitable for genome-wide analysis, were obtained from 100% and 63% of tumor samples, respectively. At the coordinating institution, approximately 40% of parents consented to autopsy and 40% declined. During the study period, 12 autopsies were obtained from patients who did not receive therapy at the coordinating center. CONCLUSIONS Multicenter, biological studies based on tissue obtained at autopsy are feasible in children with brain cancer. Our experience established a new paradigm for brain tissue collection which may increase the potential for research studies in patients with cancer. PMID:20589749

  17. 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

  18. Autopsy imaging for cardiac tamponade in a Thoroughbred foal.

    PubMed

    Yamada, Kazutaka; Sato, Fumio; Horiuchi, Noriyuki; Higuchi, Tohru; Kobayashi, Yoshiyasu; Sasaki, Naoki; Nambo, Yasuo

    2016-01-01

    Autopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conventional necropsy are considered to complement each other. The cause of death was determined to be traumatic cardiac tamponade. In conclusion, Ai is an additional option for determining cause of death.

  19. Autopsy imaging for cardiac tamponade in a Thoroughbred foal

    PubMed Central

    YAMADA, Kazutaka; SATO, Fumio; HORIUCHI, Noriyuki; HIGUCHI, Tohru; KOBAYASHI, Yoshiyasu; SASAKI, Naoki; NAMBO, Yasuo

    2016-01-01

    ABSTRACT Autopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conventional necropsy are considered to complement each other. The cause of death was determined to be traumatic cardiac tamponade. In conclusion, Ai is an additional option for determining cause of death. PMID:27703406

  20. An Autopsy Case of Amyotrophic Lateral Sclerosis with Diaphragm Pacing

    PubMed Central

    Ito, Hisashi; Kamei, Tetsumasa; Odake, Sanae; Nakano, Masayuki; Okeda, Riki; Kohriki, Shunsaku; Kawachi, Jun; Onders, Raymond P.; Yoshii, Fumihito

    2016-01-01

    Respiratory insufficiency is a critical problem in amyotrophic lateral sclerosis (ALS) patients. We herein present the case of an autopsied patient with sporadic ALS who underwent diaphragm pacing (DP). The pathology showed several localized adhesions with a markedly atrophied diaphragm. A marked loss of motor neurons with Bunina bodies and phosphorylated TDP-43 positive inclusions was found in the spinal cord and primary motor cortex. Mild hyalinization and a few multinucleated giant cells were present around the electrode tracks in the diaphragm. However, no infiltration of inflammatory cells was detected. Our findings suggest that full-time DP might not cause severe damage to adjacent diaphragm tissue. PMID:27904119

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

    PubMed

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

    2013-01-01

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

  2. Autopsy findings in Witwatersrand gold miners, 1907-1913.

    PubMed

    Ndlovu, Ntombizodwa; Murray, Jill; Davies, Anthony

    2008-06-01

    This article reports autopsy findings in black Witwatersrand gold miners who originated mainly from Portuguese East Africa. These men died at the Witwatersrand Native Labour Association compound in Johannesburg between 1907 and 1913, just over 20 years after the discovery of gold in South Africa. At that time there were shockingly high levels of death and disease on the mines. The main causes of death were pneumonia, meningitis, tuberculosis and dysentery. Pneumonia and meningitis were the principle causes of death in new recruits arriving from Portuguese East Africa and tuberculosis the main cause of mortality in referrals from the mines.

  3. Pericarditis Epistenocardica or Dressler Syndrome? An Autopsy Case

    PubMed Central

    Feola, Alessandro; De Stefano, Noè; Della Pietra, Bruno

    2015-01-01

    Postinfarction pericarditis can be classified as “early,” referred to as pericarditis epistenocardica, or “delayed,” referred to as Dressler syndrome. The incidence of postinfarction pericarditis has decreased to <5% since the introduction of reperfusion therapies and limitation of infarct size. We report on a 57-year-old man who suffered sudden cardiac death as a result of acute myocardial infarction. Autopsy revealed an area of previous infarction and fibrinous pericarditis related to the previous infarction, leading to a diagnosis of Dressler syndrome. PMID:26240567

  4. An Autopsy Case of Lepidic Pulmonary Metastasis from Cholangiocarcinoma

    PubMed Central

    Nagayoshi, Yohsuke; Yamamoto, Kazuko; Hashimoto, Satoru; Hisatomi, Keiko; Doi, Seiji; Nagashima, Seiji; Kurohama, Hirokazu; Ito, Masahiro; Takazono, Takahiro; Nakamura, Shigeki; Miyazaki, Taiga; Kohno, Shigeru

    2016-01-01

    We herein report the first case of pulmonary metastasis with lepidic growth that originated from cholangiocarcinoma. A 77-year-old man was admitted to our hospital due to exertional dyspnea and liver dysfunction. Computed tomography showed widespread infiltration and a ground-glass opacity in the lung and dilation of the intrahepatic bile duct. The pulmonary lesion progressed rapidly, and the patient died of respiratory failure. Cholangiocarcinoma and lepidic pulmonary metastasis were pathologically diagnosed by an autopsy. Lepidic pulmonary growth is an atypical pattern of metastasis, and immunopathological staining is useful to distinguish pulmonary metastasis from extrapulmonary cancer and primary pulmonary adenocarcinoma. PMID:27725547

  5. An Autopsy Case of Amyotrophic Lateral Sclerosis with Diaphragm Pacing.

    PubMed

    Ito, Hisashi; Kamei, Tetsumasa; Odake, Sanae; Nakano, Masayuki; Okeda, Riki; Kohriki, Shunsaku; Kawachi, Jun; Onders, Raymond P; Yoshii, Fumihito

    Respiratory insufficiency is a critical problem in amyotrophic lateral sclerosis (ALS) patients. We herein present the case of an autopsied patient with sporadic ALS who underwent diaphragm pacing (DP). The pathology showed several localized adhesions with a markedly atrophied diaphragm. A marked loss of motor neurons with Bunina bodies and phosphorylated TDP-43 positive inclusions was found in the spinal cord and primary motor cortex. Mild hyalinization and a few multinucleated giant cells were present around the electrode tracks in the diaphragm. However, no infiltration of inflammatory cells was detected. Our findings suggest that full-time DP might not cause severe damage to adjacent diaphragm tissue.

  6. Investigations into distribution of lidocaine in human autopsy material.

    PubMed

    Oertel, Reinhard; Arenz, Norman; Zeitz, Sten Gunnar; Pietsch, Jörg

    2015-08-01

    With screening methods in the legal medicine drugs were often detected in autopsy material. In this study the antiarrhythmic and the local anesthetic drug lidocaine could be proved in fifty-one cases and determined in different autopsy materials. For the first time the comparison of so many distribution patterns of lidocaine in human compartments was possible. A liquid-liquid extraction procedure, a standard addition method and LC/MS/MS were used for analytics. The measured concentrations in blood were in the therapeutic range or lower. The time between lidocaine application and death was given in twenty-nine cases. These data were very helpful to estimate and interpret the distribution process of lidocaine between application and death. This time exerted a crucial influence on the distribution of lidocaine in the compartments. Most of the intravenous applicated lidocaine was found in heart blood after a very short time of distribution. Afterwards the highest concentrations were measured in brain. Later the highest concentration was found in the kidney samples or in urine. If the time between lidocaine application and death is known, the results of this study can be used to deepen the knowledge of its pharmacokinetics. If this time is unknown, the circumstances and the causes of death can be better explained.

  7. [An autopsy case with cerebral histoplasmoma: case report].

    PubMed

    Arai, Takao; Fujigasaki, Junko; Arakawa, Hideki; Nagashima, Hiroyasu; Joki, Tatsuhiro; Murakami, Shigeyuki; Endou, Yasuhiko; Fukada, Takahiro; Sugita, Takashi; Abe, Toshiaki

    2004-09-01

    Histoplasma capsulatum infection is, for the most part, asymptomatic or of little clinical consequence. Disseminated infection due to H. capsulatum is rather uncommon. Clinically apparent infection of central nervous system (CNS) is rare, and involves in 10 to 50% of patients with disseminated histoplasmosis. Although CNS histoplasmosis is frequently fetal or only discovered as an autopsy, some patients can be effectively treated with anti-fungal agents. We describe a 44-year-old civil man who is engineering contractor with headache without evidence of systemic infection. Magnetic resonance imaging showed enhancing masses in the third and forth ventricles, right interpeduncular cistern, and right cerebello-pontine angle. After biopsy of what was presumed to be a malignant lymphoma, the patient died of rapidly progressive multiple cerebral infarctions. The autopsy revealed the CNS histoplasmoma disseminating systemically. And we finally diagnosed him as histoplasmoma by gene analysis. It was extremely difficult to make a diagnosis based on his physical and radiological findings because it should be included in the differential diagnosis of a well or ring enhanced lesion. It is very important to ask patients about their birthplace, past illness, occupation, and where they had traveled. In the present case, the patient working for the construction has visited many countries including the African Continent and Central America. Clinicians should maintain a high index of suspicion in patients who are from any area endemic for histoplasmosis. The clinical, radiological and pathological features of this infection were reviewed in this report.

  8. 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

  9. An autopsy case of infant death due to heat stroke.

    PubMed

    Ohshima, T; Maeda, H; Takayasu, T; Fujioka, Y; Nakaya, T

    1992-09-01

    We report an autopsy case of infant death due to heat stroke. On a winter day, a 52-day-old female baby was placed under a Japanese electric foot warmer with a coverlet (kotatsu) on an electric carpet warmer in a heated room at home. After about 5 h, the mother noticed that the baby was unconscious and took her to a hospital. Spontaneous respiration, however, was already absent, and the pupils were dilated. The trunk was hot; body temperature was 41.3 degrees C. The skin of the whole body was dry. Autopsy revealed second-degree burn injuries on the left side of the face and the dorsum of the left hand. Numerous marked petechiae and ecchymoses were found in the thymus (capsule and parenchyma), pleurae (visceral and parietal), pericardial cavity (internal and external surfaces), epicardium, and beneath the serosa at the origin of the aorta. In addition, there was congestion in various organs, edema in the brain and lungs, and hemorrhage in the lungs. Histopathologically, macrophages without hemosiderin granules were present in the alveoli. When the heating conditions at the accident were reproduced experimentally, the temperature in the electric kotatsu warmer rose to 50-60 degrees C. Thus, we concluded that misuse of the electric kotatsu caused heat stroke in this infant.

  10. An autopsy case of malignant mesothelioma associated with asbestosis.

    PubMed

    Watanabe, M; Kimura, N; Kato, M; Iwami, D; Takahashi, M; Nagura, H

    1994-01-01

    An autopsy case of malignant mesothelioma with asbestosis caused by asbestos exposure for 17 years is reported. Autopsy revealed that mesothelioma spread extensively in all serosal tissues including pleura, pericardium, diaphragm, peritoneum and tunica vaginalis testis. Histopathologically, most of the tumor showed an epithelial form, but sarcomatous and microcystic patterns were also observed. The tumor cells had abundant glycogen and hyaluronic acid and, immunohistochemically, they were positive for cytokeratin, vimentin and epithelial membrane antigen (EMA). Long, slender microvilli were characteristically observed in these tumor cells. All of these data were compatible with malignant mesothelioma. Procollagen type I (procol.l) immunostaining was performed to reveal the mesenchymal character of mesothelioma. Both epithelial-type cells and sarcomatous-type cells showed positive staining for procol.l, although the latter showed stronger immunoreactivity. Immunostaining for procol.l was found to be one of the useful tools for distinguishing mesothelioma from adenocarcinoma. Using an extraction method for asbestos fibers, asbestos bodies were found in many tissues including lymph nodes, liver, small intestine, spleen, kidney, testis and pleura, in addition to lung parenchyma. Although multiple tumor metastases from an undetermined primary site is not ruled out, 'multifocal tumorigenesis' is suspected from the widespread deposit of asbestos fibers.

  11. Autopsy practice in forensic pathology - evidence-based or experience-based? a review of autopsies performed on victims of traumatic asphyxia in a mass disaster.

    PubMed

    Colville-Ebeling, Bonnie; Freeman, Michael; Banner, Jytte; Lynnerup, Niels

    2014-02-01

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

  12. Postmortem ultrasonography of the macerated fetus complements autopsy following in utero fetal demise.

    PubMed

    Cain, Mary Ashley; Guidi, Claude B; Steffensen, Thora; Whiteman, Valerie E; Gilbert-Barness, Enid; Johnson, Dennis R

    2014-01-01

    Postmortem evaluation following an in utero fetal demise is essential for determining cause of death and counseling regarding future pregnancies. Severe maceration and fetal size along with patient desires may limit the physician's ability to perform a complete autopsy. In the cases presented, we demonstrate the utility of postmortem ultrasonography as an adjunct to traditional autopsy following fetal demise.

  13. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 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...

  14. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 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...

  15. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 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...

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

    PubMed

    Lane, Megan; Vercler, Christian J

    2016-08-01

    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.

  17. 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

  18. Trends in forensic autopsy in Chiba prefecture over the past decade.

    PubMed

    Inokuchi, Go; Ishihara, Kenji; Hayakawa, Mutsumi; Yajima, Daisuke; Makino, Yohsuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Iwase, Hirotaro

    2014-09-01

    The death investigation system in Japan is in the midst of a great transformation. As part of efforts to revise this system, in this study we analyzed the reasons the police refer unnatural death cases for forensic autopsy and, from an understanding of the trends of such referrals, we discuss the future direction of handling unnatural deaths in our country. For 1618 forensic autopsy cases handled by the First Investigation Division of Chiba Prefectural Police that were referred to our institution for forensic autopsy between 2003 and 2012, we tallied the number of autopsies by sex, age group, and reason for forensic autopsy for each year and investigated trends in the referrals over time. The results revealed that the number of autopsies increased annually from 2003 to 2012, with a marked increase from 2010. The number of autopsies increased particularly for cases of suspected criminal deaths, where it was unclear to the police before the forensic autopsy whether or not the death resulted from a criminal act. Our findings suggest that the number of forensic autopsies will continue to increase into the future in Chiba prefecture, and is a trend that is inevitable if we are to prevent criminal death cases from being overlooked. Although referrals for forensic autopsy in Japan are made only when criminal activity is suspected, the original purpose of death investigations is not only to avoid overlooking crimes, but also to flag public health issues. Therefore, together with the police, we need to review the original purpose and conduct more in-depth discussions about when referrals are necessary.

  19. 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.

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

    PubMed

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

    2015-03-01

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

  1. [An autopsy case of periarteritis nodosa associated with disseminated strongyloidiasis].

    PubMed

    Kiyuna, M; Toda, T; Tamamoto, T; Shimajiri, S; Shingaki, Y; Hokama, M; Ohwan, I

    1994-08-01

    An autopsy case of periarteritis nodosa associated with disseminated strongyloidiasis in a 59-year-old woman is reported. The patient had unknown fever of 38 degrees C and marked impairment of renal function, for which pulse therapy of steroid was performed. Electromyogram showed myogenic pattern, and biopsy of the biceps presented necrotizing angitis of small arteries. Renal biopsy showed marked infiltration of lymphocytes in the stroma, and frequent hyalinosis and crescent formation of the glomeruli. Two months after admission, the patient died of respiratory failure associated with sepsis and disseminated intravascular coagulopathy. Postmortem examination disclosed strongyloides stercolaris and fungi in both lungs with extensive hemorrhage. Terminal ileum and ascending colon had multiple erosions, extensive hemorrhage, numerous strongyloides stercolaris, and frequent necrotizing angitis in the mucosa. Necrotizing angitis was also demonstrated in both kidneys.

  2. [Malignant tumors associated with thyroid cancer in an autopsy material].

    PubMed

    Tiszlavicz, L; Varga, Z

    1991-03-17

    In the Department of Pathology of Albert Szent-Györgyi Medical University at Szeged in Hungary 37,504 autopsies were performed in the last 30 years and double multiple primary malignant tumours were found in 385 cases (4.2%). In thyroid cancer cases the tumours of other organs were more frequent (22.7%), and these tumour-associations were observed mainly simultaneously, there were no important sex differences. In the most of cases the thyroid cancer was only a side diagnosis beside other malignancies, in the more rare metachronous cases the thyroid cancer was secondary following postoperative irradiation of the first tumour (4 cases of 5). We have seen thyroid cancers most frequently together with lung, breast and digestive system tumours.

  3. Forensic Considerations in Cases of Myotonic Dystrophy at Autopsy.

    PubMed

    Omond, Kimberley J; Byard, Roger W

    2017-02-07

    Myotonic dystrophy (DM) is a chronic, slowly progressive, autosomal-dominant disorder with delayed muscle relaxation after contraction, distal skeletal muscle weakness, and atrophy. It has a reduced life expectancy due predominantly to respiratory failure or sudden cardiac death. The mortality rate is approximately 7.3 times greater than the general population with a mean age at death of 53 years. Degeneration of the cardiac conduction system causes atrioventricular block, arrhythmias, and ventricular failure. A case of sudden death in a 44-year-old woman with DM type 1 is reported to demonstrate an alternative lethal mechanism. At autopsy, there was extensive infiltration of skeletal muscles with adipose tissue. The heart was structurally normal. A deep venous thrombosis of the right calf was identified with a large saddle pulmonary thromboembolus and bilateral peripheral thromboemboli. DM1-related thrombosis had most likely occurred because of the decedent's impaired mobility, possible hypercoagulable state, and serum changes from muscle necrosis.

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

    PubMed

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

    2014-03-13

    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.

  5. An attempt to motivate internal medicine housestaff to obtain consent for autopsies.

    PubMed

    Sidorov, J

    1990-10-01

    The impact that a 50-minute lecture on the value of the autopsy had on the subsequent obtaining of autopsies by housestaff training in internal medicine at a teaching hospital was examined in a prospective one-year clinical trial from mid-1987 to mid-1988. The group that attended the lecture (n = 27) did not subsequently obtain a greater mean number or frequency of permissions for autopsies than did the control group (n = 26), whose members did not attend, and did not indicate more frequently in the patients' charts that autopsies had been sought. In addition, in the total group of 53 housestaff, five (9.4%) did not write a pronunciation-of-death entry, and 26 (49%) did not obtain permission for a single autopsy during the study period. Future efforts to enhance the appreciation for the autopsy among physicians in training may need to use more sophisticated techniques than a lecture in order to increase housestaff motivation to obtain consent for autopsies.

  6. Performance of the Tariff Method: validation of a simple additive algorithm for analysis of verbal autopsies

    PubMed Central

    2011-01-01

    Background Verbal autopsies provide valuable information for studying mortality patterns in populations that lack reliable vital registration data. Methods for transforming verbal autopsy results into meaningful information for health workers and policymakers, however, are often costly or complicated to use. We present a simple additive algorithm, the Tariff Method (termed Tariff), which can be used for assigning individual cause of death and for determining cause-specific mortality fractions (CSMFs) from verbal autopsy data. Methods Tariff calculates a score, or "tariff," for each cause, for each sign/symptom, across a pool of validated verbal autopsy data. The tariffs are summed for a given response pattern in a verbal autopsy, and this sum (score) provides the basis for predicting the cause of death in a dataset. We implemented this algorithm and evaluated the method's predictive ability, both in terms of chance-corrected concordance at the individual cause assignment level and in terms of CSMF accuracy at the population level. The analysis was conducted separately for adult, child, and neonatal verbal autopsies across 500 pairs of train-test validation verbal autopsy data. Results Tariff is capable of outperforming physician-certified verbal autopsy in most cases. In terms of chance-corrected concordance, the method achieves 44.5% in adults, 39% in children, and 23.9% in neonates. CSMF accuracy was 0.745 in adults, 0.709 in children, and 0.679 in neonates. Conclusions Verbal autopsies can be an efficient means of obtaining cause of death data, and Tariff provides an intuitive, reliable method for generating individual cause assignment and CSMFs. The method is transparent and flexible and can be readily implemented by users without training in statistics or computer science. PMID:21816107

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

    PubMed Central

    2011-01-01

    Background Verbal autopsy can be a useful tool for generating cause of death data in data-sparse regions around the world. The Symptom Pattern (SP) Method is one promising approach to analyzing verbal autopsy data, but it has not been tested rigorously with gold standard diagnostic criteria. We propose a simplified version of SP and evaluate its performance using verbal autopsy data with accompanying true cause of death. Methods We investigated specific parameters in SP's Bayesian framework that allow for its optimal performance in both assigning individual cause of death and in determining cause-specific mortality fractions. We evaluated these outcomes of the method separately for adult, child, and neonatal verbal autopsies in 500 different population constructs of verbal autopsy data to analyze its ability in various settings. Results We determined that a modified, simpler version of Symptom Pattern (termed Simplified Symptom Pattern, or SSP) performs better than the previously-developed approach. Across 500 samples of verbal autopsy testing data, SSP achieves a median cause-specific mortality fraction accuracy of 0.710 for adults, 0.739 for children, and 0.751 for neonates. In individual cause of death assignment in the same testing environment, SSP achieves 45.8% chance-corrected concordance for adults, 51.5% for children, and 32.5% for neonates. Conclusions The Simplified Symptom Pattern Method for verbal autopsy can yield reliable and reasonably accurate results for both individual cause of death assignment and for determining cause-specific mortality fractions. The method demonstrates that verbal autopsies coupled with SSP can be a useful tool for analyzing mortality patterns and determining individual cause of death from verbal autopsy data. PMID:21816099

  8. Importance of explanation before and after forensic autopsy to the bereaved family: lessons from a questionnaire study.

    PubMed

    Ito, Takako; Nobutomo, Koichi; Fujimiya, Tatsuya; Yoshida, Ken-ichi

    2010-02-01

    To investigate how bereaved families felt about the explanation received before and after forensic autopsies, the authors conducted a cross-sectional survey of the bereaved families whose next of kin underwent a forensic autopsy at the two Departments of Forensic Medicine and a few bereaved families of crime victims. Of 403 questionnaires sent, 126 families responded. Among 81.5% of the respondents who received an explanation from policemen before the autopsy, 78.8% felt that the quality of the explanation was poor or improper. In Japan, the law has restricted disclosure of information from a forensic autopsy. Despite legal restrictions, 82% wanted to hear from the person who conducted the autopsy. However, police explained the results of autopsy to 65.2% of respondents. Among the families whose frustration and anger increased after autopsy, 86.4% had not been satisfied with the explanation before the autopsy. Additionally, 57.7% had not been informed on the autopsy findings at the time of the questionnaire when more than 2 years had passed after the autopsy. These results reminded us of the importance of an explanation before and shortly after a forensic autopsy for a better understanding and acceptance by bereaved families.

  9. 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

  10. 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.

  11. 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

  12. Autometallographic tracing of bismuth in human brain autopsies.

    PubMed

    Stoltenberg, M; Hogenhuis, J A; Hauw, J J; Danscher, G

    2001-07-01

    For decades, drugs containing bismuth have been used to treat gastrointestinal disorders. Although a variety of adverse effects, including neurological syndromes, have been recorded, the biological/toxicological effects of bismuth ions are far from disclosed. Until recently, only quantitative assessments were possible, but resent research has made histochemical tracing of bismuth possible. The technique involves silver enhancement of bismuth crystallites by autometallography (AMG). In the present study, the localization of bismuth was traced by AMG in sections of paraffin-embedded brain tissue obtained by autopsy from 6 patients suffering from bismuth intoxication in a period ranging from 1975 through 1977. Tissue was analyzed at light and electron microscopical levels, and the presence of bismuth further confirmed by proton-induced x-ray emission (PIXE). Clinical data and bismuth concentrations in blood, cerebellum, and thalamus were measured by atomic absorption spectrophotometry (AAS) and are reported here. Histochemical analyses demonstrate that bismuth accumulated in neurons and glia cells in the brain regions examined (neocortex, cerebellum, thalamus, hippocampus). Cerebellar blood vessels stained most intensely. The PIXE and AAS data correlated with the histochemical staining patterns and intensities. At the ultrastructural level, bismuth was found to accumulate intracellularly in lysosomes and extracellularly in the basement membranes of some vessels.

  13. 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

  14. An autopsy case of the schizophrenic 32 years after lobotomy.

    PubMed

    Arai, Y; Tsutsui, Y; Shinmura, Y; Kosugi, T; Nishikage, H; Yamamoto, J

    2001-03-01

    An autopsy case is reported here of a 69-year-old patient with schizophrenia, who was known retrospectively to have had a prefrontal lobotomy 32 years previously. The patient was diagnosed as schizophrenic at the age of 24 and the lobotomy was undertaken 13 years later. The patient was recently found outside in a dehydrated condition and admitted to a general hospital, where he died of respiratory failure. Bilateral cystic lesions were found in the deep white matter of the frontal lobe. The cyst walls consisted of glial fibrous tissues, and severe demyelination with axonal destruction was diffusely observed in the white matter of the frontal lobe. In the thinner frontal cortex without arcuate fibers (U fibers) close to the cavities, cytoarchitectural abnormalities were observed. In the thalamic nuclei marked retrograde degeneration and astrocytic gliosis were observed. The detailed neuropathological findings of a lobotomized schizophrenic brain are reported here. It is proposed that one should be reminded of a lobotomized brain if bilateral cysts are found.

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

    PubMed

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

    2008-02-01

    The aim of this study was to compare the patterns of grey and white matter atrophy on MRI in autopsy confirmed progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD), and to determine whether the patterns vary depending on the clinical syndrome. Voxel-based morphometry was used to compare patterns of atrophy in 13 PSP and 11 CBD subjects and 24 controls. PSP and CBD subjects were also subdivided into those with a dominant dementia or extrapyramidal syndrome. PSP subjects showed brainstem atrophy with involvement of the cortex and underlying white matter. Frontoparietal grey and subcortical grey matter atrophy occurred in CBD. When subdivided, PSP subjects with an extrapyramidal syndrome had more brainstem atrophy and less cortical atrophy than CBD subjects with an extrapyramidal syndrome. PSP subjects with a dementia syndrome had more subcortical white matter atrophy than CBD subjects with a dementia syndrome. These results show regional differences between PSP and CBD that are useful in predicting the underlying pathology, and help to shed light on the in vivo distribution of regional atrophy in PSP and CBD.

  16. Risk factors for suicide in Bali: a psychological autopsy study

    PubMed Central

    Kurihara, Toshiyuki; Kato, Motoichiro; Reverger, Robert; Tirta, I Gusti Rai

    2009-01-01

    Background The suicide rate in Bali has significantly increased in recent years. However, to date, there have been no case-control studies investigating risk factors for suicide. Methods A psychological autopsy study was conducted comparing 60 suicide cases and 120 living controls matched in age, sex, and area of residence. Results Multiple logistic regression analysis identified the following risk factors for suicide: at least one diagnosis of axis-I mental disorder (OR: 14.84 CI: 6.12 - 35.94); low level of religious involvement (OR: 7.24 CI: 2.28 - 22.95); and severe interpersonal problems (OR: 3.86 CI: 1.36 - 11.01). Forty-eight (80.0%) of the suicide cases were diagnosed with mental disorders; however, only 16.7% visited a primary care health professional and none received psychiatric treatment during the 1 month prior to death. Conclusion Clinical, religious, and psychosocial factors were associated with suicide. These results highlight the significance of early recognition and treatment of mental disorders, religious activities, and interpersonal problem-solving strategies for suicide prevention in Bali. PMID:19740419

  17. 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.

  18. Brain biochemistry in autopsied patients with essential tremor.

    PubMed

    Shill, Holly A; Adler, Charles H; Beach, Thomas G; Lue, Lih-Fen; Caviness, John N; Sabbagh, Marwan N; Sue, Lucia I; Walker, Douglas G

    2012-01-01

    The pathology of essential tremor is increasingly being studied; however, there are limited studies of biochemical changes in this condition. We studied several candidate biochemical/anatomical systems in the brain stem, striatum, and cerebellum of 23 essential tremor subjects who came to autopsy, comparing them with a control population. Striatal tyrosine hydroxylase, a marker of dopaminergic neurons, was 91.7 ± 113.2 versus 96.4 ± 102.7 ng/mg (not significant) in cases and controls, respectively. Locus coeruleus dopamine beta-hydroxylase, a marker of noradrenergic neurons, was not significantly different between the essential tremor and control groups. Parvalbumin, a marker of GABAergic neurons, was 199.3 ± 42.0 versus 251.4 ± 74.8 ng/mg (P = .025) in the pons in the region of the locus coeruleus of essential tremor subjects versus controls, whereas there was no difference in cerebellar parvalbumin. These results are supportive of a possible role for reduced GABAergic function in the locus coeruleus in essential tremor. The hypothesis that essential tremor represents early Parkinson's disease was not supported, as striatal dopaminergic markers were not reduced compared with control subjects.

  19. [Glomerular IgA deposits in an autopsy study].

    PubMed

    Suganuma, T

    1994-07-01

    One hundred kidneys from 100 non-selected autopsy cases without any overt renal disease were examined by immunofluorescence to reveal the incidences and features of cases with clinically latent glomerular IgA deposits. Glomerular IgA deposits were found in 10 cases (10.0%), consisting of 4 with liver cirrhosis and 6 with other diseases. IgA deposition was observed in 4 of 13 cirrhotic patients (30.8%), 3 of 15 patients with gastrointestinal carcinoma (20.0%), one of 11 patients with cardiovascular disease (9.1%), one of 3 patients with fulminant hepatitis (33.3%), and one of 21 patients with broncho-pulmonary disease (4.8%). Light microscopy showed minor glomerular abnormalities in all non-cirrhotic cases with IgA deposits except in one case. By contrast, variable significant glomerular lesions were found in the cirrhotic cases with IgA deposits, for example mesangial proliferation and circumferential mesangial inter-position. Excluding 13 cases with liver cirrhosis, the results of urinalysis at the time of admission were available for the study in 55 of 87 cases. Forty-four of 55 cases showed normal urinalysis. Glomerular IgA deposition was found in 4 cases (9.1%) of 44 with normal urinalysis. It may be said that IgA deposition without clinical evidence of nephropathy occurred even in a normal population with an incidence of about 10%.

  20. An autopsy case of methanol induced intracranial hemorrhage.

    PubMed

    Kim, Hye-Jeong; Na, Joo-Young; Lee, Young-Jik; Park, Jong-Tae; Kim, Hyung-Seok

    2015-01-01

    The major component of car washer fluid is a methanol. Intracranial hemorrhage is a rare but lethal complication in methanol poisoning. We report a case of massive bilateral basal ganglia hematoma in a 32-year-old man with methanol poisoning. He drank car washer solution twice time (about 500 ml), and was admitted to a territorial hospital 10 hours post-ingestion for depressed mental status, lower blood pressure, and high anion gap metabolic acidosis. Computed tomographic (CT) scan showed lesions in both putamen and cerebral deep white matter. Twenty-one days after methanol exposure, he suddenly developed cardiorespiratory arrest. In autopsy, external examination revealed moderate cerebral edema, but no evidence of herniation. Coronal sections of the brain showed softening and about 34 g hematoma in the bilateral putamen and 3rd ventricles. The toxic effect of methanol on the visual system has been noted in the absence of neurologic manifestations; however, there have also been a report of concomitant brain in Korea.

  1. 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.

  2. 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

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

    PubMed

    Thali, M

    2011-11-01

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

  4. Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings.

    PubMed

    Zech, Wolf-Dieter; Jackowski, Christian; Schwendener, Nicole; Brencicova, Eva; Schuster, Frederick; Lombardo, Paolo

    2016-01-01

    In their daily forensic casework, the authors experienced discrepancies of tracheobronchial content findings between postmortem computed tomography (PMCT) and autopsy to an extent previously unnoticed in the literature. The goal of this study was to evaluate such discrepancies in routine forensic cases. A total of 327 cases that underwent PMCT prior to routine forensic autopsy were retrospectively evaluated for tracheal and bronchial contents according to PMCT and autopsy findings. Hounsfield unit (HU) values of tracheobronchial contents, causes of death, and presence of pulmonary edema were assessed in mismatching and matching cases. Comparing contents in PMCT and autopsy in each of the separately evaluated compartments of the respiratory tract low positive predictive values were assessed (trachea, 38.2%; main bronchi, 40%; peripheral bronchi, 69.1%) indicating high discrepancy rates. The majority of tracheobronchial contents were viscous stomach contents in matching cases and low radiodensity materials (i.e., HU < 30) in mismatching cases. The majority of causes of death were cardiac related in the matching cases and skull/brain trauma in the mismatching cases. In mismatching cases, frequency of pulmonary edema was significantly higher than in matching cases. It can be concluded that discrepancies in tracheobronchial contents observed between PMCT and routine forensic autopsy occur in a considerable number of cases. Discrepancies may be explained by the runoff of contents via nose and mouth during external examination and the flow back of tracheal and main bronchial contents into the lungs caused by upright movement of the respiratory tract at autopsy.

  5. Is there a need for autopsies in the management of fungal disease?

    PubMed

    Knoke, Manfred; Bernhardt, Hannelore; Schwesinger, Günther

    2008-07-01

    The autopsy rates in Germany became low like in other European, American and Asian countries. Main reasons for this development are the lack of acceptance of autopsy in the society as well as in the medical profession, the introduction of a requirement for consent, unclear legal position, the public health system, pressure of costs and a change in the field of activity in pathology with much more diagnostics of surgical and biopsy material. The autopsy is missing with respect to the reliability of causes of death and morbidity statistics and other epidemiological studies. Published data indicate that up to 20-30% of patients who die in hospitals have important diseases/lesions that remain undetected before death but that are found at autopsy. For infectious diseases, the data are similar. Therefore, a higher incidence of invasive fungal infections was found. Some rare fungal disorders are diagnosed by autopsy. Only exact death statistics makes specific health care possible and is cost saving in a public health system in the long term. Autopsy remains an important tool for quality control in medical diagnostic and therapeutic activity. It is also essential for fundamental medical education and further training.

  6. 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.

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

    PubMed

    Ylijoki-Sørensen, Seija; Boldsen, Jesper Lier; Boel, Lene Warner Thorup; Bøggild, Henrik; Lalu, Kaisa; Sajantila, Antti

    2014-11-01

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

  8. Subclinical elastofibromas in the scapular region in an autopsy series.

    PubMed

    Järvi, O H; Länsimies, P H

    1975-01-01

    In a series of 235 autopsies, changes in the subcapscular thoracic fascia similar to elastofibroma dorsi (Järvi & Saxen 1959, -et al. 1969) were found in 39 cases, all at least 58 years old. In people over 55 years, the frequency was 24.4 per cent in females and 11.2 per cent in males. In addition to hypertrophy and secondary degeneration of elastic fibres, necrosis of collagenous-, adipose-, muscular-, and nervous tissue, as well as formation of clefts, cysts and bursae was found in 85 per cent of cases presenting elastic changes--both in connection with them and outside the degenerated areas--as well as in 39 per cent of cases where no elastic degeneration occurred. Other changes included extensive scarring of the tissue, followed by reduction of fat and, more seldom, oedema and inflammatory infiltration. Breaks in the elastic cage, necrosis and fibrosis of arterial walls were found in 44 per cent of cases of elastic degeneration and in 14 per cent of cases without degeneration. In veins, more extensive wall fibrosis occurred, leading to necrosis; in cases of elastic degeneration the adventitial elastic network was also involved. Venous changes were found in 90 per cent of the cases of elastic degeneration and in 30 per cent of cases without degeneration. Direct mechanical stress on elastic tissue may be an important cause of hypertrophy and secondary degeneration of elastic fibres, and also of diffuse increase of collagenous tissue. On the other hand, nutritional deficiency due to failing resistance of the vascular system against friction of the scapula and streching movements of the upper extremities may play a main part in necrotic tissue changes.

  9. An autopsy of dead planetary systems with COS

    NASA Astrophysics Data System (ADS)

    Debes, John

    2014-10-01

    We propose to use HST/COS to conduct autopsies of dead planetary systems around UV bright hydrogen-white dwarfs (WDs), which have dust disks found via their mid-IR emission in excess of that expected from the photosphere. As part of a WISE survey, and followed up with a combination of NASA Keck HIRES/Magellan MIKE optical spectroscopy, we have identified three new systems that are accreting dust. These WDs are bright in the mid-IR and UV, gold-standard targets for studies with HST/COS and later with JWST. The dusty material is debris resulting from the tidal disruption of exo-asteroids that accrete onto the WD surface. Many atomic elements from the accreted and dissociated dust particles are detectable with COS, enabling abundance determinations of exo-asteroidal material. Moreover, the photospheric abundances of this material can be directly compared with a determination of the dust mineralogy obtained with future JWST mid-IR spectroscopy-our proposed UV observations provide complementary constraints on mineralogical compositions of the accreting dust particles. UV spectroscopy is crucial for cataloging elemental abundances for these exo-asteroids. For the majority of WDs, optical spectroscopy reveals only a couple of lines of Ca or Mg, while UV spectroscopy captures lines from Al, Fe, Si, C, Ni, O, S, Cr, P, and Ti. Obtaining the elemental abundances of exo-asteroids is comparable to the spectroscopic characterization of transiting exoplanets or protoplanetary disks-all of these techniques determine how the chemical diversity of planetary systems translate into planetary architectures and the probability of habitable planets around solar-type stars.

  10. Autopsy case of concurrent Huntington's disease and neurofibromatosis type 1.

    PubMed

    Kawakami, Ito; Katsuse, Omi; Aoki, Naoya; Togo, Takashi; Suzuki, Kyoko; Isojima, Daisuke; Kondo, Daizo; Iseki, Eizo; Kosaka, Kenji; Akiyama, Haruhiko; Hirayasu, Yoshio

    2014-03-01

    We report here an autopsy case of concurrent Huntington's disease (HD) and neurofibromatosis type 1 (NF1), also known as von Recklinghausen's disease. The patient was a Japanese woman with a significant hereditary burden: seven of her family members within four generations were affected by either NF1 or concurrent HD and NF1. She was diagnosed as having NF1 at age 24. At age 40, she showed signs of irritability, aggressive and childish behaviour, which became progressively worse. At age 48, rigidity and spastic gait were observed. One year later, choreoathetoid involuntary movements became apparent. Diagnosis of HD was made by identification of the abnormally expanded cytosine-adenine-guanine repeats in the Huntington's disease gene. Her condition deteriorated gradually to an apallic state and she died at age 60. Post-mortem examination revealed extensive brain atrophy, which was particularly severe in the frontal and temporal cortices and the striatum. The degree of neurodegenerative change seemed to correspond to grade IV. Polyglutamine positive inclusions were seen frequently in all layers of the cerebral cortex and in the amygdala and hippocampus. Inclusions were also present in the striatum, but there were fewer than in the cortex. Remarkably, neuronal intranuclear inclusions were present in the cerebellum, although they are usually not seen in HD. Features associated with the central nervous system involvement of NF1 were not found in the brain, but HD pathology might have been accelerated by the concurrence of NF1. This is the third report of a case with concurrent HD and NF1 in the world, and the first study in which occurrence of polyglutamine inclusions was confirmed on post-mortem examination.

  11. Sudden unexpected death in epilepsy: Evaluation of forensic autopsy cases.

    PubMed

    Zhuo, Luo; Zhang, Yang; Zielke, H Ronald; Levine, Barry; Zhang, Xiang; Chang, Lin; Fowler, David; Li, Ling

    2012-11-30

    Epilepsy is a common chronic neurological disorder characterized by seizures. Mortality is significantly increased in patients with epilepsy. Sudden unexpected death in epilepsy (SUDEP) is the most common seizure-related category of death. A retrospective study of forensic autopsy cases from 2007 to 2009 at the Office of the Chief Medical Examiner (OCME) yielded a total of 104 sudden unexpected deaths directly or indirectly caused by an epilepsy/seizure disorder in the State of Maryland. Of these deaths, 74 cases met a general accepted definition of SUDEP. The age of SUDEP individuals ranged from 14 to 63 with the majority of subjects in the ages between 21 and 50 years (58 cases, 78.4%). Males were slightly more likely than females to die of SUDEP (male:female=1.5:1 based on the rate). The onset age of epilepsy was documented in 47.3% of cases (35/74) based on investigation and medical records. Of the 35 cases, 12 subjects had early onset epilepsy (onset ages 1-15 years) and 20 subjects had duration of epilepsy for more than 10 years. The majority of deaths (61 of the 74 cases, 82.4%) were unwitnessed. Death scene investigation showed that 71 deaths (95.9%) occurred inside their residence with 50 subjects (70.4%) found either in bed or on the bedroom floor near the bed. Forty-three out of 74 cases (58.1%) showed neuropathological lesions. Per history, 50 subjects were reported as being on anti-epileptic drugs (AEDs). However, postmortem toxicological analysis revealed that only 26 subjects (35.1%) had detectable AEDs. Of the 74 cases, seizure disorder or epilepsy was listed as primary cause of death in 66 cases and the term of SUDEP as official cause of death in only 8 cases. This report focuses on the characteristics of death scene investigation and postmortem examination findings of SUDEP cases.

  12. Human Immunodeficiency Virus Infection Newly Diagnosed at Autopsy in New York City, 2008-2012.

    PubMed

    Ramaswamy, Chitra; Ellman, Tanya M; Myers, Julie; Madsen, Ann; Sepkowitz, Kent; Shepard, Colin

    2015-12-01

    Background.  Studying the most extreme example of late diagnosis, new HIV diagnoses after death, may be instructive to HIV testing efforts. Using the results of routine HIV testing of autopsies performed by the Office of Chief Medical Examiner (OCME), we identified new HIV diagnoses after death in New York City (NYC) from 2008 to 2012. Methods.  Population-based registries for HIV and deaths were linked to identify decedents not known to be HIV-infected before death. Multivariable logistic regression models were constructed to determine correlates of a new HIV diagnosis after death among all persons newly diagnosed with HIV and among all HIV-infected decedents receiving an OCME autopsy. Results.  Of 264 893 deaths, 24 426 (9.2%) were autopsied by the NYC OCME. Of these, 1623 (6.6%) were infected with HIV, including 142 (8.8%) with a new HIV diagnosis at autopsy. This represents 0.8% (142 of 18 542) of all new HIV diagnoses during the 5-year period. Decedents newly diagnosed with HIV at OCME autopsy were predominantly male (73.9%), aged 13-64 years (85.9%), non-white (85.2%), unmarried (81.7%), less than college educated (83.8%), and residents of an impoverished neighborhood (62.0%). Of all HIV-infected OCME decedents aged ≥65 years (n = 71), 22.0% were diagnosed at autopsy. The strongest independent correlate of new HIV diagnosis at autopsy in both multivariable models was age ≥65 years. Conclusions.  Human immunodeficiency virus diagnoses first made after death are rare, but, when observed, these diagnoses are more commonly found among persons ≥65 years, suggesting that despite highly visible efforts to promote HIV testing community-wide, timely diagnosis among older adults living in impoverished, high-prevalence neighborhoods may require additional strategies.

  13. [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

  14. Mountaineering fatalities on Mount Rainier, Washington, 1977-1997: autopsy and investigative findings.

    PubMed

    Christensen, E D; Lacsina, E Q

    1999-06-01

    Mountain climbing is a popular recreational activity with a growing number of participants and associated fatalities. To define the characteristics of these fatal incidents and the typical autopsy findings in the victims, we reviewed the autopsy and investigative findings of all fatalities that occurred on Mount Rainier from 1977 through 1997. A total of 50 deaths occurred in 29 separate incidents. Fifty-eight percent of accident victims died as the result of a fall; another 34% died as a result of an avalanche. The incidents leading to death occurred at an average altitude of 3652 m (11,977 feet); range, 2073 to 4389 m (6800-14,400 feet). The average age of the victims was 31.2 years (range, 17-55 years), and 47 of the 50 were men (94%). Bodies were not recovered in 13 cases (26%). Autopsies were performed in 30 of the remaining 37 cases. At autopsy, the cause of death was ascribed to multiple injuries in 12 cases (40%), isolated head and neck injuries in 7 cases (23%), and chest injuries in 1 case (3%). Asphyxia and hypothermia were the cause of death in 8 cases (27%) and 2 cases (7%), respectively. The frequency of specific injuries is presented by anatomic region. The unique autopsy and investigative features of mountaineering deaths are discussed.

  15. Autopsy in Islam: Considerations for Deceased Muslims and Their Families Currently and in the Future.

    PubMed

    Sajid, Mohammed Imran

    2016-03-01

    Religious beliefs and cultures have influenced treatment of dead bodies in different ways by nations throughout history, and attitudes toward the deceased individuals have changed across time and so has the role and mechanism of autopsy. Islam has been a part of Europe for a long time; therefore, we would like to emphasize the important issues for Muslims and their families regarding death, autopsy, and funeral and to describe international perspectives of Muslim autopsies. Muslims have expressed their views on autopsy publically and internationally, and there have been claims of violation of the deceased, delays in burial, and nonconsideration of their religious beliefs. In this article, we aim to increase awareness and understanding of doctors about the religious and ethical issues important to Muslims and their families, so that appropriate considerations may be made where possible with regard to respectful treatment of deceased loved ones to decrease tensions presently being faced. Forensic medicine doctors could assist by undertaking autopsy without delay, in a private room by those of the same sex, and covering parts of the body not being worked on at that time.

  16. Pulmonary disease at autopsy in patients with the acquired immunodeficiency syndrome.

    PubMed

    Wallace, J M; Hannah, J B

    1988-08-01

    To characterize the postmortem pulmonary disease and analyze the effectiveness of antemortem diagnosis, we examined the clinical records and autopsy material from 54 patients who died of the acquired immunodeficiency syndrome. At autopsy, all patients had pulmonary disease. One or more specific diagnoses were made in 53, including opportunistic infection, nonopportunistic infection, and Kaposi's sarcoma. Multiple postmortem pulmonary diagnoses were established in 37. Respiratory failure was the most common cause of death. Of the 97 pulmonary disorders discovered at autopsy, only 31 were diagnosed before death. The frequency with which infections were diagnosed during life varied according to the organism, and was significantly higher for Pneumocystis carinii than for cytomegalovirus or bacterial agents. Pulmonary Kaposi's sarcoma was diagnosed in only 7% of patients with autopsy documentation. The yield of diagnostic procedures also varied according to the disease present. Sputum culture was relatively effective in detecting Cryptococcus neoformans and Mycobacterium avium-intracellulare, fiber-optic bronchoscopy was extremely useful for diagnosing P Carinii, and one or more diagnoses were provided in 4 of 7 patients who underwent thoracotomy, but significant disease including cytomegalovirus infection and pulmonary Kaposi's sarcoma was frequently missed. Although the spectrum of lung disease found at autopsy is similar to that observed during life, the frequency of some pathologic processes including cytomegalovirus infection and Kaposi's sarcoma may be underrepresented in antemortem series.

  17. Diagnostic discrepancies in clinical practice: An autopsy study in patients with heart failure.

    PubMed

    Issa, Victor Sarli; Dinardi, Layara Fernanda Lipari; Pereira, Thiago Vicente; de Almeida, Lyna Kyria Rodrigues; Barbosa, Thaisa Silveira; Benvenutti, Luiz Alberto; Ayub-Ferreira, Silvia Moreira; Bocchi, Edimar Alcides

    2017-01-01

    Autopsies are the gold standard for diagnostic accuracy; however, no recent study has analyzed autopsies in heart failure (HF).We reviewed 1241 autopsies (January 2000-May 2005) and selected 232 patients with HF. Clinical and autopsy diagnoses were analyzed and discrepancies categorized according to their importance regarding therapy and prognosis.Mean age was 63.3 ± 15.9 years; 154 (66.4%) patients were male. The causes of death at autopsy were end-stage HF (40.9%), acute myocardial infarction (17.2%), infection (15.9), and pulmonary embolism 36 (15.5). Diagnostic discrepancies occurred in 191 (82.3%) cases; in 56 (24.1%), discrepancies were related to major diagnoses with potential influence on survival or treatment; pulmonary embolism was the cause of death for 24 (42.9%) of these patients. In 35 (15.1%), discrepancies were related to a major diagnosis with equivocal influence on survival or treatment; in 100 (43.1%), discrepancies did not influence survival or treatment. In multivariate analysis, age (OR: 1.03, 95% CI: 1.008-1.052, P = 0.007) and presence of diabetes mellitus (OR: 0.359, 95% CI: 0.168-0.767, P = 0.008) influenced the occurrence discrepancies.Diagnostic discrepancies with a potential impact on prognosis are frequent in HF. These findings warrant reconsideration in diagnostic and therapeutic practices with HF patients.

  18. Molecular identification of fungi found on decomposed human bodies in forensic autopsy cases.

    PubMed

    Schwarz, Patrick; Dannaoui, Eric; Gehl, Axel; Felske-Zech, Heike; Birngruber, Christoph G; Dettmeyer, Reinhard B; Verhoff, Marcel A

    2015-07-01

    To investigate which fungi can be found during forensic autopsies, a PubMed literature review was done in regard to fungal growth on decomposed human bodies. Unfortunately, the existing data is limited and not all fungi were identified to the species level. We, therefore, collected skin samples with macroscopically visible fungal growth from 23 autopsy cases in Germany and identified the fungi to the species level by molecular methods. The identified species included Aspergillus fumigatus and Candida albicans, which pose an allergenic risk, especially to persons with underlying lung diseases. Because safety standards are lacking, we recommend the use of respiratory protection during exhumations and forensic autopsies, when fungal growth is noted. With regard to the future, a database was set up which could possibly be used as a forensic tool to determine the time of death.

  19. 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

  20. 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.

  1. An autopsy report of acute myocardial infarction with hypertrophic obstructive cardiomyopathy-like heart.

    PubMed

    Ushikoshi, Hiroaki; Okada, Hideshi; Morishita, Kentaro; Imai, Hajime; Tomita, Hiroyuki; Nawa, Takahide; Suzuki, Kodai; Ikeshoji, Haruka; Kato, Hisaaki; Yoshida, Takahiro; Yoshida, Shozo; Shirai, Kunihiro; Toyoda, Izumi; Hara, Akira; Ogura, Shinji

    2015-01-01

    An 84-year-old woman, who was followed up as hypertrophic obstructive cardiomyopathy (HOCM) in a local hospital, was transferred to our center because of anterior chest pain and diagnosed with acute myocardial infarction (MI). Coronary angiography showed total occlusion of the mid-left anterior descending, and flow was restored after endovascular thrombectomy. An autopsy was performed after she died on hospital day 6. At autopsy, there was no significant stenosis in this vessel and the absence of plaque rupture was confirmed. Likewise, it was unclear asymmetric hypertrophy at autopsy, it could not deny that a sigmoid deformity of the basal septum occurs in elderly patients and can mimic the asymmetric septal hypertrophy of hypertrophic cardiomyopathy. MI was thought to be caused by coronary spasm or squeezing in HOCM-like heart. Therefore, it may be necessary antithrombosis therapy in HOCM-like patients with no history of paroxysmal atrial fibrillation.

  2. Clinical or Postmortem? The Importance of the Autopsy; a Retrospective Study

    PubMed Central

    COSTACHE, Mariana; LAZAROIU, Anca Mihaela; CONTOLENCO, Andreea; COSTACHE, Diana; GEORGE, Simion; SAJIN, Maria; PATRASCU, Oana Maria

    2014-01-01

    Medicine is continually evolving; the new technologies of diagnosis and treatment continue to improve the life expectancy and lead to new information concerning various pathologies. The autopsy is viewed more and more as an ultimate branch of medicine and used only in extreme cases or for forensic purposes. Nevertheless, many studies, including this one, prove the utility and indispensability of the autopsies, without which a complete and accurate diagnosis cannot be made. Finally, the autopsy followed by histopathological examination of the tissues remains the ultimate and most important step for the apprehension of the diseases and for further evolution of medicine. This study reveals the correspondence rate between the clinical and the postmortem diagnosis, as well as between macroscopic and histopathological diagnosis. PMID:25705288

  3. 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.

  4. Safe decontamination of hospital autopsy rooms and ventilation system by formaldehyde generation.

    PubMed

    Coldiron, V R; Janssen, H E

    1984-02-01

    Space decontamination was required prior to the onset of a remodeling project in the autopsy suite of a large university-hospital complex. The National Institutes of Health procedure using formaldehyde gas as a disinfectant was modified to decontaminate not only the three autopsy rooms but also the exhaust ductwork and the three associated air incinerators. Modifications included an automated formaldehyde gas generator, a smoke test procedure for leaks, and an exhausting technique. This procedure proved to be successful and has the advantage of including the safety features necessary to conduct such a potentially hazardous decontamination in an occupied hospital.

  5. 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.

  6. Epidemiology and sites of involvement of invasive fungal infections in patients with haematological malignancies: a 20-year autopsy study.

    PubMed

    Lewis, Russell E; Cahyame-Zuniga, Lizebeth; Leventakos, Konstantinos; Chamilos, Georgios; Ben-Ami, Ronen; Tamboli, Pheroze; Tarrand, Jeffrey; Bodey, Gerald P; Luna, Mario; Kontoyiannis, Dimitrios P

    2013-11-01

    Autopsy studies remain an essential tool for understanding the patterns of fungal disease not detected ante mortem with current diagnostic approaches. We collected data concerning the microbiological trends, patient clinical characteristics and sites of involvement for invasive fungal infections (IFIs) identified at autopsy in a single large cancer treatment centre over a 20-year period (1989-2008). The autopsy rate and IFI prevalence both declined significantly during the study period. The prevalence of Aspergillus spp. decreased significantly from the first 15 years of the study (from 0.12 to 0.14 cases per 100 autopsies to 0.07 in 2004-2008; P = 0.04), with only Mucorales accounting for a greater proportion of IFIs over the duration of the study period (0.06 to 0.2 cases per 100 autopsies, P = 0.04). After 2003, moulds accounted for the majority of infections identified at autopsy in the spleen, kidney, heart and gastrointestinal tract. Despite a trend of decreasing prevalence from 1989 to 2004, invasive candidiasis increased in prevalence during later periods 2004-2008 (0.02-0.05 per 100 autopsies) with decreasing kidney, heart and spleen involvement. Despite a declining autopsy rate, these data suggest a decreasing prevalence overall of IFIs with changing patterns of dissemination in patients with haematological malignancies.

  7. A Comparison Between Clinical Diagnosis of Death and Autopsy Diagnosis. A Retrospective Study of 131 Newborns, Stillborns and Aborted Fetuses

    PubMed Central

    COSTACHE, Mariana; CIRSTOIU, Monica; CONTOLENCO, Andreea; LAZAROIU, Anca Mihaela; GEORGE, Simion; SAJIN, Maria; PATRASCU, Oana Maria

    2014-01-01

    In recent years, the autopsy was considered necessary only in medico-legal cases, or when the clinician requires it to better understand the pathology and cause of death (with the deceased family's consent). Although it has been shown in numerous studies that the autopsy and the postmortem histopathological examination are the only ones that can diagnose correctly and completely, the autopsy rate is declining. The primary motive of the family in consenting to a perinatal necropsy, may be to determine the cause of death of their child and to be aware of possible complications of their future pregnancy. This study shows the rate of concordance between clinical diagnosis and autopsy diagnosis, and the rate of concordance between macroscopic diagnosis and microscopic findings, pointing out once again the importance and the utility of the autopsy in medical practice. PMID:25705276

  8. [Creating language model of the forensic medicine domain for developing a autopsy recording system by automatic speech recognition].

    PubMed

    Niijima, H; Ito, N; Ogino, S; Takatori, T; Iwase, H; Kobayashi, M

    2000-11-01

    For the purpose of practical use of speech recognition technology for recording of forensic autopsy, a language model of the speech recording system, specialized for the forensic autopsy, was developed. The language model for the forensic autopsy by applying 3-gram model was created, and an acoustic model for Japanese speech recognition by Hidden Markov Model in addition to the above were utilized to customize the speech recognition engine for forensic autopsy. A forensic vocabulary set of over 10,000 words was compiled and some 300,000 sentence patterns were made to create the forensic language model, then properly mixing with a general language model to attain high exactitude. When tried by dictating autopsy findings, this speech recognition system was proved to be about 95% of recognition rate that seems to have reached to the practical usability in view of speech recognition software, though there remains rooms for improving its hardware and application-layer software.

  9. Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study.

    PubMed

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

    2012-01-01

    Involvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS) is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV) and the importance of these lesions to death. Of these, 90 (96.8%) patients had AIDS. We reviewed medical records, autopsy reports and histological sections from tongue to rectum stained with hematoxylin-eosin. When necessary, we analyzed special stains and immunohistochemistry to investigate infections. There was damage to the digestive system in 73 (78.5%) cases. The most common infections were candidiasis (42%), cytomegalovirus (29%), histoplasmosis (11.8%), toxoplasmosis (9.7%) and mycobacterial infection (9.7%). Malignancies were rare, present in four (4.3%) cases (two Kaposi's sarcoma, one adenocarcinoma and one metastatic embryonal carcinoma). All segments showed lesions: tongue (48.6%), esophagus (44.8%), stomach (44.7%), colon (43.2%) and small intestine (28.9%). The lesions found were immediate cause of death in five (5.4%) cases. In another 36 (38.7%) cases the basic disease was systemic and also compromised the digestive system.

  10. 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…

  11. 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…

  12. 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…

  13. Psychosocial and Psychiatric Factors Associated with Adolescent Suicide: A Case-Control Psychological Autopsy Study

    ERIC Educational Resources Information Center

    Portzky, Gwendolyn; Audenaert, Kurt; van Heeringen, Kees

    2009-01-01

    This study aimed at the investigation of psychosocial and psychiatric risk factors of adolescent suicide by means of a case-control psychological autopsy study. Relatives and other informants of 19 suicide victims and 19 matched psychiatric controls were interviewed by means of a semi-structured interview schedule. Psychiatric controls included…

  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. 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…

  16. Congenital High Airway Obstruction Syndrome (CHAOS) as part of Fraser syndrome: ultrasound and autopsy findings.

    PubMed

    Mesens, T; Witters, I; Van Robaeys, J; Peeters, H; Fryns, J P

    2013-01-01

    Congenital High Airway Obstruction Syndrome (CHAOS) is a potential lethal condition. We describe a case report of CHAOS, with additional malformations diagnosed at 20 weeks. Autopsy findings are suggestive for Fraser syndrome (cryptophthalmos-syndactyly syndrome; OMIM 219000). The diagnosis was confirmed by mutation analysis of FRAS1.

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

    SciTech Connect

    Landas, S.; Turner, J.W.; Moore, K.C.; Mitros, F.A.

    1984-03-01

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

  18. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... performed on the body of a deceased patient only by direction of the officer in charge and only if consented... death involved. Restrictions or limitations imposed by the person consenting thereto on the extent of the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  19. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... performed on the body of a deceased patient only by direction of the officer in charge and only if consented... death involved. Restrictions or limitations imposed by the person consenting thereto on the extent of the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  20. Diagnostic accuracy of postmortem imaging vs autopsy-A systematic review.

    PubMed

    Eriksson, Anders; Gustafsson, Torfinn; Höistad, Malin; Hultcrantz, Monica; Jacobson, Stella; Mejare, Ingegerd; Persson, Anders

    2017-04-01

    Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.

  1. 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

  2. Post-mortem forensic neuroimaging: correlation of MSCT and MRI findings with autopsy results.

    PubMed

    Yen, Kathrin; Lövblad, Karl-Olof; Scheurer, Eva; Ozdoba, Christoph; Thali, Michael J; Aghayev, Emin; Jackowski, Christian; Anon, Javier; Frickey, Nathalie; Zwygart, Karin; Weis, Joachim; Dirnhofer, Richard

    2007-11-15

    Multislice-computed tomography (MSCT) and magnetic resonance imaging (MRI) are increasingly used for forensic purposes. Based on broad experience in clinical neuroimaging, post-mortem MSCT and MRI were performed in 57 forensic cases with the goal to evaluate the radiological methods concerning their usability for forensic head and brain examination. An experienced clinical radiologist evaluated the imaging data. The results were compared to the autopsy findings that served as the gold standard with regard to common forensic neurotrauma findings such as skull fractures, soft tissue lesions of the scalp, various forms of intracranial hemorrhage or signs of increased brain pressure. The sensitivity of the imaging methods ranged from 100% (e.g., heat-induced alterations, intracranial gas) to zero (e.g., mediobasal impression marks as a sign of increased brain pressure, plaques jaunes). The agreement between MRI and CT was 69%. The radiological methods prevalently failed in the detection of lesions smaller than 3mm of size, whereas they were generally satisfactory concerning the evaluation of intracranial hemorrhage. Due to its advanced 2D and 3D post-processing possibilities, CT in particular possessed certain advantages in comparison with autopsy with regard to forensic reconstruction. MRI showed forensically relevant findings not seen during autopsy in several cases. The partly limited sensitivity of imaging that was observed in this retrospective study was based on several factors: besides general technical limitations it became apparent that clinical radiologists require a sound basic forensic background in order to detect specific signs. Focused teaching sessions will be essential to improve the outcome in future examinations. On the other hand, the autopsy protocols should be further standardized to allow an exact comparison of imaging and autopsy data. In consideration of these facts, MRI and CT have the power to play an important role in future forensic

  3. 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.

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

    PubMed

    Eto, Komyo; Tokunaga, Hidehiro; Nagashima, Kazuo; Takeuchi, Tadao

    2002-01-01

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

  5. 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

  6. 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

  7. A psychological autopsy study of suicidal hanging from Cuttack, India: focus on stressful life situations.

    PubMed

    Bastia, Binaya K; Kar, Nilamadhab

    2009-01-01

    Factors and stressful life situations associated with suicidal hanging in a sample from India were studied with a view to explore preventability. Information was collected on consecutive suicidal hanging victims in a 2-year period from various sources including family members through psychological autopsy method. Out of 662 autopsies involving suicide during the study period, 104 had used hanging as the method. Age group of 21-30 years, married females, unmarried males, dowry related stress, unemployment, prolonged illness, failure in examinations, relationship and financial problems were associated more frequently with suicidal hanging. Stresses stemming from social practices and perceptions are linked with considerable number of suicidal hanging, which suggest priority areas for intervention.

  8. A philosophical assessment of TK's autopsy report: Implications for the debate over the brain death criteria.

    PubMed

    Austriaco, Nicanor Pier Giorgio

    2016-05-01

    In recent years, there has been increasing evidence that the totally brain-dead patient is able to continue to live and to maintain some integrated functions, albeit with the necessary assistance of mechanical ventilation. Several years ago, the autopsy report of a totally brain-dead patient named TK who was kept on life support for nearly twenty years was published in the Journal of Child Neurology. He remains the individual kept on life support the longest after suffering total brain failure. In this essay, I argue that the clinical data described in the autopsy report demonstrate that TK's long-term survival after total brain failure supports the claim acknowledged by the President's Council on Bioethics that the brain-dead patient retains his bodily integrity. As such, he is not dead. He is still a living, though severely disabled, human organism, a human person made in the image and likeness of God.

  9. An autopsy case of the Marburg variant of multiple sclerosis (acute multiple sclerosis).

    PubMed

    Suzuki, Makiko; Kawasaki, Hideya; Masaki, Katsuhisa; Suzuki, Satoshi O; Terada, Tatsuhiro; Tsuchida, Takashi; Tokuyama, Tsutomu; Kono, Satoshi; Komori, Takashi; Baba, Satoshi; Kira, Jun-ichi; Miyajima, Hiroaki

    2013-01-01

    We herein report an autopsy case of the Marburg variant of multiple sclerosis (MS). A 29-year-old woman developed acute and progressive neurological symptoms. A diagnosis of MS was suspected based on the patient's clinical background and brain MRI findings and the lack of evidence of malignancy on a brain biopsy. Despite the administration of typical treatment for MS, a fatal outcome occurred three months after disease onset. The autopsy revealed multiple inflammatory demyelinating lesions in the central nervous system. In addition, two noteworthy histopathological features were observed compared with prototypical MS. We evaluate the pathogenic differences between the Marburg type and prototypical MS by discussing the neuropathology and cerebrospinal fluid (CSF) findings of our case.

  10. John Paul Jones: An Overlooked Autopsy Finding that May Explain His Terminal Illness.

    PubMed

    Hamrell, Burt B

    2016-03-01

    A finding in the autopsy of John Paul Jones, the American Revolutionary War naval hero, may explain his terminal illness. During his last 2 years, he had a persistent productive cough and dyspnea. Ten days before death, he developed rapidly progressive dependent edema and ascites. He died in France in 1792. His body, preserved in alcohol in a lead coffin, was, in 1905, removed to the United States. Glomerulonephritis was noted on an autopsy, performed in France, but there was no comment then or since about ventricular wall thickness being the same in both ventricles at 5-6 mm. Hypertrophy and dilatation with biventricular failure followed by tissue shrinkage during 113 years in alcohol could have resulted in these ventricular wall findings. Systemic hypertension and left ventricular failure are consistent with his respiratory symptoms complicated perhaps by pulmonary emboli, right ventricular failure with tricuspid regurgitation, peripheral congestion, and jaundice.

  11. Autopsy confirmation of severe pulmonary interstitial fibrosis secondary to Munchausen syndrome presenting as cystic fibrosis.

    PubMed

    Croft, Philip R; Racz, Mark I; Bloch, John D; Palmer, Charles H

    2005-09-01

    Chronic factitious disorder with physical symptoms, or Munchausen syndrome, is a well-recognized but uncommonly diagnosed psychiatric condition characterized by the deliberate production of signs and symptoms of disease in order to receive medical attention. Clinical suspicion of this disease is rarely confirmed by autopsy, as the patients usually do not die as a consequence of feigning illness. Here we report the autopsy confirmation of a case of a suspected Munchausen syndrome patient who presented with a history of cystic fibrosis. Examination of the lungs demonstrated extensive severe interstitial fibrosis, and polariscopic examination revealed a large quantity of crystalline material throughout the tissue; X-ray diffraction identified the material as talc. Synopses of published cases of Munchausen syndrome presenting as cystic fibrosis, and cases of Munchausen syndrome with pulmonary talcosis are presented as part of the discussion.

  12. Fetal echopsy (ultrasonographic autopsy) of an acardius myelancephalus and its correlation with antenatal ultrasonographic findings

    PubMed Central

    Karippaliyil, Balakumar; Karippaliyil, Milind; Karippaliyil, Misha

    2015-01-01

    Aberrant transplacental arteriovenous shunts between the placental and cord vessels of monozygotic monoamniotic twins or triplets result in the formation of an acardius. The prenatal diagnosis of this condition has been reported occasionally in the literature. A subtype categorized as acardius myelancephalus was diagnosed at 32 weeks of gestation by ultrasonography (USG). The pregnancy was aborted because of poor prognostic predictors and the acardius was subjected to ultrasonographic autopsy (fetal echopsy). The antenatal USG features were correlated with echopsy findings for confirmation of the antenatal findings and for a better visual perception of the prenatal diagnostic features. The echopsy revealed more precise details. Fetal echopsy avoids the medicolegal problems concerned with parental consent for classical invasive fetal autopsy. PMID:26752828

  13. Membrane autopsy based bio-fouling investigation of distillery spent wash RO treatment plant.

    PubMed

    Sharma, Pinki; Joshi, Himanshu

    2014-01-01

    In this paper, a thorough investigation has been done to evaluate the effects of different pollutants on membrane performance by autopsy. Autopsy was performed on fresh and fouled reverse osmosis (RO) membrane elements from a distillery spent wash treatment plant by different analyses, such as field emission scanning electron microscopy, atomic force microscopy, Fourier transform infrared spectroscopy and X-ray diffraction, to identify the cause of poor performance of an RO plant. Results obtained from the analysis of membranes indicate that a mixture of colloids and organic matters (polysaccharides and amines) along with the presence of multivalent ions (Ca, Mg, Fe and SO4) causes membrane fouling, which in turn affects membrane performance. Possible measures to improve treated effluent quality and mitigate fouling have been suggested for this particular case study.

  14. Autopsy reenactment--a useful technique in the evaluation of adhesive tape asphyxia.

    PubMed

    Herbst, Jonathon; Stanley, Wayne; Byard, Roger W

    2014-05-01

    A 19-year-old woman was found dead with her face and head wrapped in plastic adhesive tape in a cupboard beside an opened helium cylinder. Despite the alleged presence of a suicide message on a social networking website, the unusual circumstances raised the possibility at the time of autopsy of either accidental death from sexual asphyxia or homicide. A carefully monitored reenactment demonstrated, however, that the type of commercial adhesive tape that had been used did not cause complete airway obstruction and that it was possible to wrap a considerable length of tape around the head and neck with the breath held. All of the features at autopsy were, therefore, compatible with self-infliction. Asphyxial death was attributed to the combined effects of smothering from tape and anoxia from helium, an extremely rare combination in young females.

  15. Cardiac injuries in car occupants in fatal motor vehicle collisions--an autopsy-based study.

    PubMed

    Turk, Elisabeth E; Tsang, Yee-Wah; Champaneri, Anisha; Pueschel, Klaus; Byard, Roger W

    2010-08-01

    Motor vehicle accidents contribute widely to population morbidity and mortality around the world, and cardiac injuries are a major factor determining outcome. Autopsy reports from 380 motor vehicle occupants who died in motor vehicle crashes in Adelaide, Australia, and Hamburg, Germany, over a 6-year period were reviewed, analysing the presence and type of cardiac injuries and their correlation with factors such as crash type, presence of seatbelt/airbag and vehicle speed as well as with the presence of other injuries which might predict the presence of cardiac injuries in a clinical setting. 21.1% had cardiac injuries identified macroscopically autopsy or histology. Cardiac injuries were the only cause of death or contributed to a fatal outcome in 76% of these cases. Sternal fractures and left-sided serial rib fractures were predictive of cardiac injury.

  16. Heterogeneity in fetal akinesia deformation sequence (FADS): autopsy confirmation in three 20-21-week fetuses.

    PubMed

    Yfantis, H; Nonaka, D; Castellani, R; Harman, C; Sun, C-C

    2002-01-01

    Fetal akinesia deformation sequence (FADS) is a rare condition characterized by intrauterine growth retardation (IUGR), congenital limb contractures, pulmonary hypoplasia, hydramnios and craniofacial abnormalities. The present report comprises an autopsy study of three fetuses to illustrate the variable clinical manifestations and neuropathological findings. Fetus 1 had arthrogryposis and no movement on fetal ultrasound examination. Aborted at 21 weeks, the fetus showed micrognathia, bilateral joint contracture with pterygia at the elbow and axilla. Growth retardation and pulmonary hypoplasia were not major features. Neuropathologic examination revealed anterior horn cell loss and lateral corticospinal tract degeneration in spinal cord, with marked muscular atrophy. Fetus 2, 20 weeks' gestation, had fetal akinesia, nuchal thickening, left pleural effusion, and Dandy-Walker malformation on ultrasound examination. Autopsy showed low-set ears, ocular hypertelorism, cleft palate, flexion contractures with pterygia over axilla, elbow and groin, pulmonary hypoplasia, Dandy-Walker malformation, unremarkable spinal cord and skeletal muscle. Fetus 3, 21 weeks' gestation, was aborted for fetal akinesia, neck and limb webbing and severe arthrogryposis. At autopsy, similar facial abnormalities, contracture and pterygia in neck and multiple major joints were found. Borderline pulmonary hypoplasia and severe lumbar scoliosis were also present. The brain, spinal cord and muscle were unremarkable. In these three fetuses, the prenatal ultrasound and autopsy findings were characteristic of FADS. Neurogenic spinal muscular atrophy was the basis of fetal akinesia in Case 1. Dandy-Walker malformation was present in Case 2, but the pathogenetic mechanism of fetal akinesia was not clear as spinal cord and muscle histology appeared normal. The etiology of akinesia was undetermined in Case 3; no extrinsic or intrinsic cause was identified.

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

    PubMed

    Balakumar, K; Misha, K

    2010-07-01

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

  18. Autopsy validation of 123I-FP-CIT dopaminergic neuroimaging for the diagnosis of DLB

    PubMed Central

    Attems, Johannes; Colloby, Sean J.; O'Brien, John T.; McKeith, Ian; Walker, Rodney; Lee, Lean; Burn, David; Lett, Debra J.; Walker, Zuzana

    2017-01-01

    Objective: To conduct a validation study of 123I-N-fluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) nortropane (123I-FP-CIT) SPECT dopaminergic imaging in the clinical diagnosis of dementia with Lewy bodies (DLB) with autopsy as the gold standard. Methods: Patients >60 years of age with dementia who had undergone 123I-FP-CIT imaging in research studies and who had donated their brain tissue to the Newcastle Brain Tissue Resource were included. All had structured clinical research assessments, and clinical diagnoses were applied by consensus panels using international diagnostic criteria. All underwent 123I-FP-CIT imaging at baseline, and scans were rated as normal or abnormal by blinded raters. Patients were reviewed in prospective studies and after death underwent detailed autopsy assessment, and neuropathologic diagnoses were applied with the use of standard international criteria. Results: Fifty-five patients (33 with DLB and 22 with Alzheimer disease) were included. Against autopsy diagnosis, 123I-FP-CIT had a balanced diagnostic accuracy of 86% (sensitivity 80%, specificity 92%) compared with clinical diagnosis, which had an accuracy of 79% (sensitivity 87%, specificity 72%). Among patients with DLB, 10% (3 patients) met pathologic criteria for Lewy body disease but had normal 123I-FP-CIT imaging. Conclusions: This large autopsy analysis of 123I-FP-CIT imaging in dementia demonstrates that it is a valid and accurate biomarker for DLB, and the high specificity compared with clinical diagnosis (20% higher) is clinically important. The results need to be replicated with patients recruited from a wider range of settings, including movement disorder clinics and general practice. While an abnormal 123I-FP-CIT scan strongly supports Lewy body disease, a normal scan does not exclude DLB with minimal brainstem involvement. Classification of evidence: This study provides Class I evidence that 123I-FP-CIT dopaminergic neuroimaging accurately identifies patients with DLB

  19. Methodological trends in studies based on verbal autopsies before and after published guidelines

    PubMed Central

    Kengne, Andre Pascal; Neal, Bruce

    2009-01-01

    Abstract Objective To report on the uptake of guidelines published in the early 1990s with specific recommendations about the design of future studies based on verbal autopsy conducted for mortality surveillance. Methods We conducted a systematic literature search of all verbal autopsy studies published before January 2006 and extracted from the studies a standard set of data. We then compared studies designed before and after the recommendations were issued in terms of seven key methodological indicators. Findings We found 102 studies conducted in 39 countries; 60 were designed before and 42 after the guidelines were issued. The methods used in these 102 studies varied considerably. While some encouraging trends were noted, there is no evidence that the design recommendations have been systematically implemented. Specifically, there was no clear increase in the proportion of studies with a combined questionnaire (63% before recommendations versus 74% after; P = 0.3), a trained interviewer (70% versus 70%; P = 1.0), a suitable respondent (98% versus 100%; P = 1.0), an optimal recall period (84% versus 97%; P = 0.2), predefined algorithms (28% versus 38%; P = 0.4), an option for assigning multiple causes of death (30% versus 38%; P = 0.3), or a follow-up validation study (83% versus 72%; P = 0.7). Conclusion Expert recommendations for optimal design of verbal autopsy studies have been incompletely implemented to date. Better uptake of design recommendations through enhanced collaboration between research teams is likely to produce better mortality statistics from an increasing number of verbal autopsy studies. PMID:19784447

  20. Catastrophic antiphospholipid antibody syndrome in systemic lupus erythematosus: an autopsy case report of a young woman.

    PubMed

    Mizuno, R; Fujimoto, S; Fujimoto, T; Nishino, T; Shiiki, H; Hashimoto, T; Nakamura, S; Dohi, K

    2000-10-01

    Catastrophic antiphospholipid syndrome (CAPS) is a severe variant of antiphospholipid syndrome (APS) characterized by disseminated microangiopathy that results in multiorgan failure. CAPS mainly occurs in association with systemic lupus erythematosus (SLE). Clinically, CAPS mimics disseminated SLE vasculitis, intravascular coagulation (DIC), and particularly thrombotic thrombocytopenic purpura (TTP). We describe an autopsy case of young woman with CAPS in SLE, which is difficult to differentiate from TTP secondary to SLE.

  1. Manner of Death Determination in Fire Fatalities: 5-Year Autopsy Data of Istanbul City.

    PubMed

    Esen Melez, İpek; Arslan, Murat Nihat; Melez, Deniz Oguzhan; Gürler, Ahmet Selçuk; Büyük, Yalçin

    2017-03-01

    Death resulting from burns is an important social problem and a frequent accident. However, because approximately 10% of cases are estimated to result from a fire that was deliberately started, all fire-related deaths should be treated as suspicious, and the cause of a fire should be investigated. For the bodies recovered from the scene of a fire, the manner of death could also be suicide or homicide. The objective of this study was to contribute to the clarification of controversial data present in the literature on the manner of death determination of fire-related deaths, through evaluation of autopsy findings of bodies recovered from fires. We reviewed 20,135 autopsies performed in a 5-year period, in Istanbul, as the whole autopsy data of the city and found 133 fire-related deaths. The death scene investigation reports and other judicial documents, autopsy findings, and toxicological analysis results were evaluated to determine the parameters of age, sex, level of the burn, vital signs [red flare; soot in the lower respiratory tract, esophagus, and/or stomach; and screening of carboxyhemoglobin (COHb) levels in the blood], toxicological substances, presence of accelerants, cause of death, and manner of death. The manner of death was determined to be an accident in 98 (73.7%) and homicide in 12 (9%) cases, whereas there was no suicide. In addition, it could not be determined in 23 (17.2%) cases. In accidental deaths, the most frequent cause of death was COHb poisoning with statistically significant blood COHb levels greater than 10%. Further, the presence of soot in the lower respiratory tract, esophagus, and/or stomach and the existence of at least 1 or 2 vital signs together were found to be valid deterministic criteria with statistical significance in terms of identifying the manner of death.

  2. 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

  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.

  4. Hyponatremia at autopsy: an analysis of etiologic mechanisms and their possible significance.

    PubMed

    Byramji, Angela; Cains, Glenda; Gilbert, John D; Byard, Roger W

    2008-01-01

    While electrolyte measurements after death may be confounded by a number of variables, vitreous humor sodium tends to remain stable for some time, enabling correlation between ante- and postmortem levels. Review of natural and unnatural causes of reduced vitreous humor sodium levels at autopsy was undertaken to demonstrate the range of diseases that may result in this finding. Natural diseases affecting the vasopressin-renin-angiotensin axis may cause reduction in sodium levels with associated hypovolemia, euvolemia, and hypervolemia. Low sodium measurements may also occur with redistribution of water, and artefactually when there are underlying lipid and protein disorders. Unnatural causes of hyponatremia at autopsy include water intoxication from psychogenic polydipsia, environmental polydipsia, ingestion of dilute infant formulas, beer potomania, endurance exercise, fresh water immersion (including water births) and iatrogenic causes including drug and parenteral fluid administration, and surgical irrigation. A knowledge of the range of conditions that may result in lowered postmortem sodium levels will help to exclude or confirm certain diseases at autopsy. In addition, significant vitreous hyponatremia may be a useful finding to help clarify mechanisms of unnatural deaths.

  5. [Occurrence of cysticercosis in autopsies performed in Uberlandia, Minas Gerais, Brazil].

    PubMed

    Costa-Cruz, J M; Rocha, A; Silva, A M; De Moraes, A T; Guimarães, A H; Salomão, E C; Alcântara, T M

    1995-06-01

    3937 autopsies were performed between 1971 and 1993 in the Serviço de Anatomia Patológica of the Hospital de Clínicas of the Fundação de Assistência, Estudo e Pesquisa de Uberlândia, Universidade Federal de Uberlândia, in Minas Gerais, Brazil. At this Service of Pathology are realized all the autopsies of the municipal district of Uberlândia. The analysis of 2862 concluded autopsy reports, of death above the age of one year, disclosed 39 cases (1.4%) of cysticercosis. The age range was 16 to 83 years and 66.6% were males; 82.1% of the patients were from Minas Gerais State, 15.4% were from Goiás State, and in one case (2.5%) the origin was not registered. From these 39 cases, 35 (89.7%) showed central nervous system involvement, isolated or in association to other clinical forms of the disease; in 9 occurred the isolated or associated cardiac form; in 4 the muscular form, isolated or associated, was found; 4 presented the isolated or associated visceral form. In only 7 (17.9%) cases, the cysticercosis was assumed to be the direct cause of the death.

  6. 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.

  7. Simultaneous determination of drugs in human autopsy material using phase-optimized liquid chromatography.

    PubMed

    Oertel, R; Pietsch, J; Arenz, N; Zeitz, S G; Goltz, L; Kirch, W

    2012-12-01

    In legal medicine in many cases drugs are detected in autopsy material without connection to the cause of death, and until now no further investigations have taken place. In our study more than 50 drugs were measured directly in several compartments. The deceased had received continual therapeutic treatment, treatment during an operation or an unsuccessful emergency therapy. Liquid-liquid extraction and an LC-MS/MS method were developed for the determination of these drug concentrations. When measuring many transitions in a biological matrix, two problems should be excluded: ion suppression and too few measurement points per peak. A relatively short operation time and sufficient separation were achieved by column, eluent and gradient optimization with POPLC (phase-optimized liquid chromatography). Various autopsy materials from about 170 cases were investigated. In particular, in nine cases with four or more simultaneously determined drugs, their distribution in the compartments is very interesting for pharmacokinetic examinations. The distribution patterns of the drugs in the compartments of one individual deceased were compared. This meant that the great differences between subjects that are normally encountered these studies could be excluded. Measurements of drug concentrations in human autopsy material deepens knowledge of the respective drugs' pharmacokinetics.

  8. An autopsy-confirmed case of progressive supranuclear palsy with predominant postural instability.

    PubMed

    Kurz, Carolin; Ebersbach, Georg; Respondek, Gesine; Giese, Armin; Arzberger, Thomas; Höglinger, Günter Ulrich

    2016-11-14

    Postural instability and supranuclear gaze palsy represent the key symptoms of Richardson's syndrome, the most frequent clinical manifestation of progressive supranuclear palsy (PSP). However, a proportion of PSP patients never develops ocular motor symptoms, which prevents clinicians from establishing the diagnosis during lifetime according to current diagnostic criteria. We present one instructive autopsy-confirmed PSP case with prospective video-documented clinical course, showing striking temporal divergence of initially present postural instability and delayed development of ocular motor dysfunction. Brain imaging and autopsy findings were typical of PSP, but the temporal sequence of symptoms was unusual with isolated postural instability predominating the clinical course for many years and slowing of vertical saccades/supranuclear gaze palsy evolving not until the 9(th)/11(th) year after disease onset. Although other differential diagnoses were unlikely, this patient did not pass the threshold for possible or probable diagnosis of PSP according to current diagnostic criteria until very late in the disease course. This first well documented, autopsy confirmed case of PSP with predominant postural instability further expands the clinical spectrum of PSP and points out the need of new clinical diagnostic criteria with sufficient sensitivity and specificity for an early and reliable diagnosis.

  9. 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

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

    PubMed

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

    2014-11-01

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

  11. French retrospective multicentric study of neonatal hemochromatosis: importance of autopsy and autoimmune maternal manifestations.

    PubMed

    Collardeau-Frachon, Sophie; Heissat, Sophie; Bouvier, Raymonde; Fabre, Monique; Baruteau, Julien; Broue, Pierre; Cordier, Marie-Pierre; Debray, Dominique; Debiec, Hanna; Ronco, Pierre; Guigonis, Vincent

    2012-01-01

    Neonatal hemochromatosis is a rare disease that causes fetal loss and neonatal death in the 1st weeks of life and is one of the most common causes of liver failure in the neonate. The diagnosis is mostly made retrospectively, based on histopathologic features of severe liver fibrosis associated with hepatic and extrahepatic siderosis. Several etiologies may underlie this phenotype, including a recently hypothesized gestational alloimmune disease. Fifty-one cases of liver failure with intrahepatic siderosis in fetuses and neonates were analyzed retrospectively. Maternal and infant data were collected from hospitalization and autopsy reports. All available slides were reviewed independently by 3 pathologists. Immunologic studies were performed on maternal sera collected immediately after delivery. The diagnosis of neonatal haemochromatosis was retained in 33 cases, including 1 case with Down syndrome and 1 case with myofibromas. Liver siderosis was inversely proportional to fibrosis progression. In fetuses, iron storage was more frequent in the thyroid than in the pancreas. Perls staining in labial salivary glands was positive in 1 of 5 cases. Abnormal low signal intensity by magnetic resonance imaging was detected in the pancreas in 2 of 7 cases. Renal tubular dysgenesis was observed in 7 of 23 autopsy cases. Chronic villitis was seen in 7 of 15 placentas. Half of the mothers presented with an autoimmune background and/or autoantibodies in their sera. Our work highlights the importance of autopsy in cases of neonatal hemochromatosis and marshals additional data in support of the hypothesis that neonatal hemochromatosis could reflect maternal immune system dysregulation.

  12. Estimation of actinide skeletal content in humans based on bone samples collected at autopsy.

    PubMed

    Filipy, R E; Alldredge, J R; Hall, C A; McInroy, J F; Glover, S E; Qualls, S

    2003-01-01

    The USTUR has developed simple linear and multiple regression models for estimating skeletal actinide concentrations on the basis of bone samples collected at autopsies of non-whole body tissue donors. Bone samples usually collected include a clavicle, the patella(e), one or more ribs, the sternum, and a vertebral wedge cut from within the abdominal cavity. The described models were derived by regression analyses with the analytical results from those bones and the entire skeletons of eight whole body donations to the USTUR. With the model, skeletal concentrations of 238Pu, (239+240)Pu, and 241Am can be estimated from wet or ashed actinide concentrations in one to five of the bones usually collected at autopsy and analyzed. Application of the models to a selected USTUR non-whole body donation (Case 0240) indicated that the skeletal actinide concentration estimates were reasonably precise and that there was good agreement between the results from individual bones with wet or ashed actinide concentrations. The USTUR will apply the model that is based on wet concentrations of bones to estimate skeletal concentrations of actinides in all non-whole body autopsy cases for the sake of consistency because of the large number of early cases for which ashed weights of bones were not recorded.

  13. Agreement between death certificate and autopsy diagnoses among atomic bomb survivors.

    PubMed

    Ron, E; Carter, R; Jablon, S; Mabuchi, K

    1994-01-01

    Based on the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation series of over 5,000 autopsies, we examined death certificate accuracy for 12 disease categories and assessed the effect of potential modifying factors on agreement and accuracy. The overall percentage agreement between death certificate and autopsy diagnoses was only 52.5%. Although neoplasms had the highest detection rate, almost 25% of cancers diagnosed at autopsy were nevertheless missed on death certificates. Confirmation and detection rates were above 70% for neoplasms and external causes of death only. Confirmation rates were between 50 and 70% for infectious diseases and heart and other vascular diseases. Detection rates reached a similar level for infectious, cerebrovascular, and digestive diseases. Specificity rates were above 90% for all except the cerebrovascular disease category. Overall agreement decreased with increasing age at death and was worse for deaths occurring outside of hospital. There was some suggestion that agreement improved over time, but no indication that radiation dose, sex, city of residence, or inclusion in a biennial clinical examination program influenced agreement. Since the inaccuracy of death certificate diagnoses can have major implications for health research and planning, it is important to be aware that their accuracy is low and that it can vary widely depending on cause, age and place of death.

  14. Immunohistochemical localization of heat shock protein 70 in the human medulla oblongata in forensic autopsies.

    PubMed

    Nogami, M; Takatsu, A; Endo, N; Ishiyama, I

    1999-12-01

    Heat shock protein 70 (hsp70) can be induced under various stresses in experimental animals. We investigated hsp70 immunoreactivity in the human medulla oblongata in forensic autopsies. Hsp70 immunoreactivity was observed in the cytoplasm of some neurons in the hypoglossal nucleus (XII), the dorsal motor nucleus of the vagal nerve (X), the lateral cuneate nucleus (Cun), and the inferior olive (Oli). Neurons with positive hsp70 immunoreactivity were statistically significantly fewer in the Oli than in the XII, X, and Cun. There was no statistically significant correlation between the AMI (the antemortem interval between the onset of injury and death) or PMI (the postmortem interval between death and autopsy), and the percentage of positive cytoplasmic hsp70 immunoreactivity in any of the nuclei studied. Age had a statistically significant negative correlation with the percentage of positive hsp70 immunoreactivity in the Oli. The percentages of positive hsp70 immunoreactivity in the XII and Cun were statistically significantly lower in burn cases than in other cases. Therefore, the induction of hsp70 immunoreactivity in the medulla oblongata may not reflect the duration of stress in the AMI, but may reflect the regional (nuclei) and conditional (burns) differences in autopsy specimens.

  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. Proposed classes of morphological autopsy findings for decomposed and skeletal remains in mass death investigations.

    PubMed

    Komar, Debra; Lathrop, Sarah; Potter, Wendy

    2008-12-01

    Analysis of mass death events, often involving partial or skeletal human remains, requires investigators to condense information on a large number of victims into a single report. Prosecution of war crimes typically requires that victims be categorized according to the injuries sustained. Reports recognizing only the presence or absence of trauma are misleading or misrepresentative. This study introduces a 4 class system for skeletal remains based on morphologic autopsy findings. Each class corresponds to the lethal potential of the trauma or pathologic conditions evident at autopsy, and the certainty with which cause of death can be determined. Data were extracted from 766 autopsy cases involving decomposed or skeletal remains from the New Mexico Office of the Medical Investigator in which cause and manner of death were ruled. Statistically significant associations between morphology class and the cause and manner of death, positive identification, and natural and non-natural deaths were evident in this study. Intraobserver and interobserver tests revealed excellent replicability and reliability in the assignment of morphology classes to individual cases. In addition to its mass death applications, this classification system offers potential research contributions to physical anthropologists and bioarchaeologists studying human populations in antiquity.

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

    PubMed Central

    2011-01-01

    Background Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician-certified verbal autopsy (PCVA) using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 VAs. The study was also designed to analyze issues related to PCVA, such as the impact of a second physician reader on the cause of death assigned, the variation in performance with and without household recall of health care experience (HCE), and the importance of local information for physicians reading VAs. Methods The certification was performed by 24 physicians. The assignment of VA was random and blinded. Each VA was certified by one physician. Half of the VAs were reviewed by a different physician with household recall of health care experience included. The completed death certificate was processed for automated ICD-10 coding of the underlying cause of death. PCVA was compared to gold standard cause of death assignment based on strictly defined clinical diagnostic criteria that are part of the Population Health Metrics Research Consortium (PHMRC) gold standard verbal autopsy study. Results For individual cause assignment, the overall chance-corrected concordance for PCVA against the gold standard cause of death is less than 50%, with substantial variability by cause and physician. Physicians assign the correct cause around 30% of the time without HCE, and addition of HCE improves performance in adults to 45% and slightly higher in children to 48%. Physicians estimate cause-specific mortality fractions (CSMFs) with considerable error for adults, children, and neonates. Only for neonates for a cause list of six causes with HCE is accuracy above 0.7. In all three age groups, CSMF accuracy improves when household recall of health care experience is available. Conclusions Results show that physician coding for cause of death

  18. Histopathologic Findings in Autopsies with Emphasis on Interesting and Incidental Findings-A Pathologist’s Perspective

    PubMed Central

    Rajalakshmi, B.R.; Manjunath, G.V.

    2016-01-01

    Introduction Autopsy aids to the knowledge of pathology by unveiling the rare lesions which are a source of learning from a pathologist’s perspective Some of them are only diagnosed at autopsy as they do not cause any functional derangement. This study emphasizes the various incidental lesions which otherwise would have been unnoticed during a person’s life. Aim The aim of this study was to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death. It was also aimed to highlight various incidental and interesting lesions in autopsies. Materials and Methods A retrospective study of medicolegal autopsies for six years was undertaken in a tertiary care centre to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death and to highlight various incidental and interesting lesions in autopsies. Statistical Analysis: Individual lesions were described in numbers and incidence in percentage. Results The study consisted of a series of 269 autopsy cases and histopathological findings were studied only in 202 cases. The commonest cause of death was pulmonary oedema. The most common incidental histopathological finding noted was atherosclerosis in 55 (27.2%) cases followed by fatty liver in 40 (19.8%) cases. Neoplastic lesions accounted for 2.47% of cases. Conclusion This study has contributed a handful of findings to the pool of rare lesions in pathology. Some of these lesions encountered which served as feast to a pathologist are tumour to tumour metastasis, a case with coexistent triple lesions, Dubin Johnson syndrome, von Meyenburg complex, Multilocular Cystic Renal Cell Carcinoma (MCRCC), Autosomal Dominant Polycystic Kidney Disease (ADPKD), liver carcinod and an undiagnosed vaso-occlusive sickle cell crisis. Autopsy studies help in the detection of unexpected findings significant enough to have changed patient management had they been

  19. Risk factor analysis for bone marrow histiocytic hyperplasia with hemophagocytosis: an autopsy study.

    PubMed

    Inai, Kunihiro; Noriki, Sakon; Iwasaki, Hiromichi; Naiki, Hironobu

    2014-07-01

    The excessive release of inflammatory cytokines occasionally induces life-threatening hemophagocytosis referred to as hemophagocytic syndrome (HPS). A similar condition, histiocytic hyperplasia with hemophagocytosis (HHH), is often seen in bone marrow collected during autopsy. Unlike HPS, the pathogenesis of HHH remains unclear. Therefore, we performed a clinicopathological analysis of HHH from 70 autopsy cases at the University of Fukui Hospital. HHH was detected in 29 of 70 autopsies (41.4 %) and was significantly complicated with hematological diseases (p < 0.05) and sepsis (p < 0.05). The percentage of macrophages in bone marrow (BM) nucleated cells was significantly increased in HHH (p < 0.001). Data from medical records indicated no significant changes, except for the minimum values of white blood cell counts (p < 0.05) and platelet counts (p < 0.05) in HHH patients as compared with non-HHH patients. Concentrations of inflammatory mediators including IL-1β, IL-6, and IL-8 were significantly increased in HHH patients. Multivariate risk factor analysis identified hematological diseases (odds ratio (OR), 11.71), ≥ 15 % BM macrophages (OR, 9.42), sepsis (OR, 7.77), and high serum IL-6 levels (OR, 1.00) as independent risk factors for HHH. HHH with hypocellular BM, the most aggressive form of HHH, was recognized in 8 of 29 HHH patients and was associated with ≥ 25 % BM macrophages (p < 0.001), leukocytopenia (p < 0.05), and high IL-8 levels (p < 0.05). None of the HHH patients fulfilled the diagnostic criteria of HPS. These findings suggest that HHH is a different entity from HPS and that it preferentially develops under conditions of excessive inflammation and its associated risks, such as hematological diseases and sepsis.

  20. A 2-Year Psychological Autopsy Study of Completed Suicides in the Athens Greater Area, Greece

    PubMed Central

    Michopoulos, Ioannis; Christodoulou, Christos; Koutsaftis, Filippos; Lykouras, Lefteris; Douzenis, Athanassios

    2015-01-01

    Objective To study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece. Methods We studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire. Results 335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note. Conclusion Our study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece. PMID:25866522

  1. 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.

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

    PubMed

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

    2013-05-01

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

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

    PubMed

    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 student perceptions of, and attitudes towards, the educational value of autopsy. Our aim was to investigate these perceptions by designing a brief qualitative study comprising nominal technique and focus group discussions with Cambridge Graduate Course students, all of whom had attended autopsies. Three general themes emerged from the focus group discussions: the value of autopsy as a teaching tool and ways the experience could be improved, the initial impact of the mortuary and the autopsy itself, and the "emerging patient"-an emotional continuum running from cadaver to autopsy subject and living patient. Educational benefits of autopsy-based teaching included greater understanding of anatomy and physiology, greater appreciation of the role of other health care professionals and an enhanced appreciation of psycho-social aspects of medical practice. Students suggested improvements for ameliorating the difficult emotional consequences of attendance. We conclude that autopsy-based teaching represents a low-cost teaching technique which is highly valued by students and has application to many diverse medical specialties and skills. However, careful preparation and organization of sessions is required to maximize potential educational benefits and reduce any negative emotional impact.

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

    2011-01-01

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

  6. Autopsy findings in AIDS--a histopathological analysis of fifty cases.

    PubMed

    Falk, S; Schmidts, H L; Müller, H; Berger, K; Schneider, M; Schlote, W; Helm, E B; Stille, W; Hübner, K; Stutte, H J

    1987-07-15

    Fifty consecutive AIDS autopsy cases were evaluated. All subjects showed one or more opportunistic infections and malignancies included in the AIDS case definition with cytomegalovirus and Kaposi's sarcoma being most prevalent. Mycobacterial and cryptococcal infections occurred only infrequently. Most patients of our series after successful treatment of Pneumocystis carinii pneumonia or cerebral toxoplasmosis later succumbed to less treatable conditions like disseminated cytomegalovirus or fungal infections or malignant lymphoma. In the absence of specific treatment for the HIV infection leading to these lethal complications special emphasis must be put on the prevention of HIV transmission and spread.

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

    SciTech Connect

    Schulte-Altedorneburg, Gernot; Droste, Dirk W.; Kollar, Jozsef; Hegedues, Csaba; Gomba, Szabolcs; Ringelstein, E. Bernd; Csiba, Laszlo

    2000-07-15

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

  8. Efficacy of drug screening in forensic autopsy: retrospective investigation of routine toxicological findings.

    PubMed

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

    2015-05-01

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

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

    PubMed

    Prasad, Goli Penchala; Babu, G; Swamy, G K

    2006-01-01

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

  10. Fraser syndrome: affected siblings born to nonconsanguineous parents and diagnosed at autopsy.

    PubMed

    De Jong, Ann; Warren, Miranda; Rehrauer, William; Harter, Josephine; Baraboo, Melissa; Chandra, Sunita; Pauli, Richard M; Singer, Don B; Fritsch, Michael K

    2008-01-01

    Fraser syndrome (MIM 219000) is a rare genetic disorder with major features including cryptophthalmos, syndactyly, and genital anomalies. We report 2 independently autopsied children of the same nonconsanguineous parents. The siblings exhibit similar clinical features, all of which are consistent with a diagnosis of Fraser syndrome. The gross and microscopic findings provide insight into the highly variable clinical presentation of Fraser syndrome. Molecular diagnostic studies of the index case failed to identify one of the known gene mutations in the FRAS1 and FREM2 genes associated with Fraser syndrome. This raises the possibility that other genes or undetected mutations in the FRAS1/FREM2 genes may cause Fraser syndrome.

  11. An Autopsy Case of Aortic Intimal Sarcoma Initially Diagnosed as Polyarteritis Nodosa

    PubMed Central

    Toyoda, Yuko; Ozaki, Ryohiko; Kishi, Jun; Hanibuchi, Masaki; Kinoshita, Katsuhiro; Tezuka, Toshifumi; Goto, Hisatsugu; Ono, Hiroyuki; Nagai, Kojiro; Bando, Yoshimi; Doi, Toshio; Nishioka, Yasuhiko

    2016-01-01

    A 61-year-old man had hypertension with stenosis in the left renal artery. When his fever, abdominal pain, and renal dysfunction progressed, he was admitted to our hospital. He was diagnosed with polyarthritis nodosa. His renal function rapidly deteriorated despite immunosuppressive therapy. His digestive tract perforated twice, and he subsequently died. An autopsy revealed that aortic intimal sarcoma caused stenosis in multiple arteries. Both polyarteritis nodosa and aortic intimal sarcoma are very rare diseases and the diagnoses are very difficult. It is very important to consider these entities when making a differential diagnosis of vasculitis. PMID:27803418

  12. An autopsy case of systemic hemangiomatosis with honeycomb-like liver and focal splenic sarcomatoid changes.

    PubMed

    Tsukagoshi, H; Iwasaki, Y; Toyoda, M; Sato, T; Takagi, H; Mori, M; Sasaki, A; Kumakura, H; Ishijima, H; Aoki, J

    1998-10-01

    An unusual autopsy case of systemic hemangiomatosis associated with honeycomb-like liver and splenic sarcomatoid changes is presented. The patient suffered from high-output ventricular heart failure secondary to hepatic arteriovenous shunting with hepatic failure, ending fatally due to disseminated intravascular coagulation and pulmonary bleeding. Postmortem examination revealed the characteristic distribution of vasoformative tumors presenting in the hematopoietic system including the liver, bone marrow, and spleen, with the liver appearing characteristically honeycomb-like. While these vasoformative tumors were mostly benign-appearing, partial shifts toward sarcomatoid change were observed in the splenic lesions.

  13. 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.

  14. 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

  15. Parity factors and prevalence of fibrocystic breast change in a forensic autopsy series.

    PubMed Central

    Pathak, D. R.; Pike, M. C.; Key, C. R.; Teaf, S. R.; Bartow, S. A.

    1991-01-01

    The relationship of reproductive factors, such as nulliparous vs ever-parous status, age at first birth, and total parity, with morphologic prevalence of fibrocystic changes were examined using autopsy material from three ethnic/racial groups at varying risks for breast cancer. Although there was a trend toward a protective effect of ever-parous status, there was no statistically significant difference in the prevalence of fibrocystic disease in any group defined by parity status. The ethnic differences in the prevalence of fibrocystic changes were not explained by the differences in parity status distribution for the three ethnic/racial groups. PMID:2069834

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

    PubMed

    Czerner, Frank

    2010-01-01

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

  17. 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

  18. 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.

  19. Measuring mortality due to HIV-associated tuberculosis among adults in South Africa: Comparing verbal autopsy, minimally-invasive autopsy, and research data

    PubMed Central

    Tlali, Mpho; Fielding, Katherine L.; Charalambous, Salome; Chihota, Violet N.; Churchyard, Gavin J.; Hanifa, Yasmeen; Johnson, Suzanne; McCarthy, Kerrigan; Martinson, Neil A.; Omar, Tanvier; Kahn, Kathleen; Chandramohan, Daniel; Grant, Alison D.

    2017-01-01

    Background The World Health Organization (WHO) aims to reduce tuberculosis (TB) deaths by 95% by 2035; tracking progress requires accurate measurement of TB mortality. International Classification of Diseases (ICD) codes do not differentiate between HIV-associated TB and HIV more generally. Verbal autopsy (VA) is used to estimate cause of death (CoD) patterns but has mostly been validated against a suboptimal gold standard for HIV and TB. This study, conducted among HIV-positive adults, aimed to estimate the accuracy of VA in ascertaining TB and HIV CoD when compared to a reference standard derived from a variety of clinical sources including, in some, minimally-invasive autopsy (MIA). Methods and findings Decedents were enrolled into a trial of empirical TB treatment or a cohort exploring diagnostic algorithms for TB in South Africa. The WHO 2012 instrument was used; VA CoD were assigned using physician-certified VA (PCVA), InterVA-4, and SmartVA-Analyze. Reference CoD were assigned using MIA, research, and health facility data, as available. 259 VAs were completed: 147 (57%) decedents were female; median age was 39 (interquartile range [IQR] 33–47) years and CD4 count 51 (IQR 22–102) cells/μL. Compared to reference CoD that included MIA (n = 34), VA underestimated mortality due to HIV/AIDS (94% reference, 74% PCVA, 47% InterVA-4, and 41% SmartVA-Analyze; chance-corrected concordance [CCC] 0.71, 0.42, and 0.31, respectively) and HIV-associated TB (41% reference, 32% PCVA; CCC 0.23). For individual decedents, all VA methods agreed poorly with reference CoD that did not include MIA (n = 259; overall CCC 0.14, 0.06, and 0.15 for PCVA, InterVA-4, and SmartVA-Analyze); agreement was better at population level (cause-specific mortality fraction accuracy 0.78, 0.61, and 0.57, for the three methods, respectively). Conclusions Current VA methods underestimate mortality due to HIV-associated TB. ICD and VA methods need modifications that allow for more specific

  20. Pancake kidney with a single ureter: a rare incidental observation at autopsy.

    PubMed

    Kanchan, Tanuj; Murlimanju, B V; Saralaya, Vasudha V

    2017-01-01

    We report an extremely rare case of a pancake kidney with a single ureter. During the medicolegal autopsy on the body of a traffic accident victim, the kidneys were not located in the abdomen. The anterior surfaces of both kidneys were completely fused in the pelvic cavity, and the kidney was shaped like a pancake. This pancake kidney had accessory renal arteries around it and one renal vein from each kidney. The left renal vein was much smaller in diameter than the right one. There were two major calyces, one each from each kidney. The major calyces joined to form a single renal pelvis from both the kidneys, which continued as a single ureter. The renal pelvis and ureter lay posterior to the pancake kidney. Urologists and pelvic surgeons should be aware of the variant anatomy of the pancake kidney, particularly concerning its vasculature, to prevent unexpected catastrophic bleeding. If the kidneys are not located in the abdominal cavity, the autopsy surgeon must consider the possibility of its presence in the pelvic cavity. This could be especially important during medicolegal investigations into allegations of missing kidneys and unlawful kidney transplantations.

  1. [An autopsy case of amyotrophic lateral sclerosis associated with cervical syringomyelia].

    PubMed

    Hamada, K; Sudoh, K; Fukaura, H; Yanagihara, T; Hamada, T; Tashiro, K; Isu, T

    1990-06-01

    An autopsied case of amyotrophic lateral sclerosis complicated by cervical syringomyelia was reported. The case was a 59-year-old man, who first noticed weakness of both lower extremities at 54-year-old. The weakness spread to both upper extremities within 2 years. Cervical myelography revealed multi-level cervical spondylosis and anterior fusion of C5-C7 was done. But the weakness and atrophy of proximal muscle, diminished deep tendon reflex on upper extremities, hyperreflexia and pathological reflexes on both legs, tongue fasciculation and respiratory muscle weakness developed successively, and the patient died of respiratory distress at 59-year-old. Autopsy revealed multiple independent four syrinxes located at the level between C2-C7. One of these syrinxes had ependymal cell lining and thought to be idiopathic syringomyelia. The other three syrinxes were considered to be the cavitation in association with cervical spondylotic myelopathy. Degeneration and decreasing of spinal anterior horn cells, atrophy of medullary pyramis and Bunina bodies were observed as features of typical amyotrophic lateral sclerosis. Cervical spondylosis as causative lesion of multiple syrinxes was discussed, and relationship between ALS and the syrinxes was not indicated clearly.

  2. 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.

  3. 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

  4. Association between Cysticercosis and Neoplasia: A Study Based on Autopsy Findings

    PubMed Central

    Cavellani, Camila Lourencini; da Silva, Aline Cristina Souza; Ribeiro, Grace Kelly Naves de Aquino; Oliveira, Lívia Ferreira; Ferraz, Mara Lúcia Fonseca; Teixeira, Vicente de Paula Antunes

    2013-01-01

    Chronic infections including the cysticercosis induce inflammatory cells to produce free radicals and synthesize carcinogenic toxins. The cells with genetic mutations proliferate in a disorganized manner, leading to the development of neoplasia. The aim of the present study was to demonstrate the relation between cysticercosis and neoplasia. Patients autopsied were divided into 4 groups: patients with neoplasia and cysticercosis (NC), patients with neoplasia only (NN), patients with cysticercosis only (CC), and patients without neoplasia or cysticercosis (WW). Of 2012 autopsy reports analyzed, 0.4 showed NC. In groups CC and NC, the most common location of the parasite was the brain. There was a predominance of three or more cysticerci in groups NC and CC. In the NC group, all had malignant neoplasms, and was predominance of benign neoplasm in NN group. The digestive system was the most frequent neoplasia. By calculating odds ratio, rate of neoplasia in patients with cysticercosis was 0.74. In conclusion, the demographic profile of patients with cysticercosis and neoplasia is similar to that of patients with cysticercosis alone. The incidence of cysticercosis and neoplasia was greater in older patients suggesting that immunosenescence may contribute to development of neoplasia promoted by cysticercosis. PMID:24288510

  5. Low-grade Schwann cell neoplasms with leptomeningeal dissemination: clinicopathologic and autopsy findings.

    PubMed

    Rodriguez, Erika F; Blakeley, Jaishri; Langmead, Shannon; Olivi, Alessandro; Tufaro, Anthony; Tabbarah, Abeer; Berkenblit, Gail; Sacks, Justin M; Newsome, Scott D; Montgomery, Elizabeth; Rodriguez, Fausto J

    2017-02-01

    Leptomeningeal dissemination of low-grade Schwann cell neoplasms is an exceptionally rare occurrence and has not been well documented in the literature. We encountered 2 cases of leptomeningeal dissemination of low-grade Schwann cell neoplasms. Patient 1 was a 63-year-old woman with neurofibromatosis type 1 and a progressive low-grade malignant peripheral nerve sheath tumor developing from a diffuse/plexiform orbital neurofibroma that arose in childhood. The neoplasm demonstrated local and leptomeningeal dissemination intracranially leading to the patient's death. There was partial loss of H3K27 tri-methylation, p16 and collagen IV. Patient 2 was a 60-year-old man without neurofibromatosis type 1 who presented with cranial nerve symptoms and a disseminated neoplasm with a Schwann cell phenotype. The neoplasm stabilized after irradiation and chemotherapy, but the patient died of medical complications. Autopsy findings documented disseminated leptomeningeal disease in the intracranial and spinal compartment. H3K27M tri-methylation was preserved. The clinicopathologic and autopsy findings are studied and presented, and the literature is reviewed.

  6. 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.

  7. Association between cysticercosis and neoplasia: a study based on autopsy findings.

    PubMed

    Cavellani, Camila Lourencini; da Silva, Aline Cristina Souza; Ribeiro, Grace Kelly Naves de Aquino; Oliveira, Lívia Ferreira; Ferraz, Mara Lúcia Fonseca; Teixeira, Vicente de Paula Antunes

    2013-01-01

    Chronic infections including the cysticercosis induce inflammatory cells to produce free radicals and synthesize carcinogenic toxins. The cells with genetic mutations proliferate in a disorganized manner, leading to the development of neoplasia. The aim of the present study was to demonstrate the relation between cysticercosis and neoplasia. Patients autopsied were divided into 4 groups: patients with neoplasia and cysticercosis (NC), patients with neoplasia only (NN), patients with cysticercosis only (CC), and patients without neoplasia or cysticercosis (WW). Of 2012 autopsy reports analyzed, 0.4 showed NC. In groups CC and NC, the most common location of the parasite was the brain. There was a predominance of three or more cysticerci in groups NC and CC. In the NC group, all had malignant neoplasms, and was predominance of benign neoplasm in NN group. The digestive system was the most frequent neoplasia. By calculating odds ratio, rate of neoplasia in patients with cysticercosis was 0.74. In conclusion, the demographic profile of patients with cysticercosis and neoplasia is similar to that of patients with cysticercosis alone. The incidence of cysticercosis and neoplasia was greater in older patients suggesting that immunosenescence may contribute to development of neoplasia promoted by cysticercosis.

  8. [Strategy for investigation of forensic autopsy cases where drugs or poisonous substances are involved].

    PubMed

    Kimura, K

    1999-11-01

    In recent years, the number of drug- or toxin-related criminal cases has gradually increased, and accordingly the establishment of precise forensic autopsy examinations and appropriate chemical analysis is of urgent importance so that such cases are not overlooked. To this end, the author has set up a general instructional objective comprising "preparation of the most suitable analytical procedures for elucidation of drug- and/or poison-related cases in a forensic medicine laboratory". Specific objectives within the general instructional objective consist of the following: 1) securing adequate manpower, 2) swift acquisition and accumulation of the latest scientific information, 3) sufficient examinations during forensic autopsy, 4) appropriate collection and storage of human tissues, 5) enforcement of preliminary tests and routine examinations, 6) selection of proper analytical procedures and instruments for qualitative and quantitative analysis, 7) establishment of reliable quantitative analysis, 8) signification of quantitative data, 9) preparation of an accurate analytical report. In our laboratory, we have been able to analyze many kinds of acidic and basic substances as well as volatile hydrocarbons, alcohol and carboxyhemoglobin through the use of absorptimetry, gas chromatography, gas chromatography/mass spectrometry and high performance liquid chromatography, however it is thought that more skillful techniques should be developed as soon as possible with regard to the analysis of inorganic and water-soluble agents.

  9. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) - literature review apropos an autopsy case.

    PubMed

    Wesołowski, Wojciech; Dziewulska, Dorota; Koziarska, Malwina; Iżycka-Świeszewska, Ewa

    2015-09-01

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a non-atherosclerotic, non-amyloid cerebral angiopathy involving small arteries and arterioles. This entity presents vascular changes in the form of smooth muscle degeneration with swollen myocytes and PAS-positive granular deposits, together with vascular fibrosis and hyalinization. In parallel, diffuse white matter destruction with infarcts, tissue rarefaction, spongiosis, lacunes and demyelination are characteristic. Ultrastructurally, vascular granular osmiophilic material (GOM) is pathognomonic for this hereditary disease caused by NOTCH3 mutation. We diagnosed CADASIL in the autopsy examination of a 53-year-old woman with a 9-year history of a progressive neurological disease with complex motor and cognitive deficits, accompanied by non-specific diffuse white matter changes on neuroimaging. Despite several multicentre hospitalizations, the precise diagnosis was not established until the post-mortem examination of the brain was made. CADASIL is a rare entity, but it should be considered by a pathologist in a differential diagnosis of vascular diseases of the brain, especially in cases with atypical clinical presentation and familial history. The prompt diagnosis depends on the quality of the brain autopsy and proper sampling. The post mortem examination, where “Morituri vivos docent”, is still significant.

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

    PubMed

    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.

  11. [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).

  12. 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

  13. Personality and resilience to Alzheimer's disease neuropathology: a prospective autopsy study.

    PubMed

    Terracciano, Antonio; Iacono, Diego; O'Brien, Richard J; Troncoso, Juan C; An, Yang; Sutin, Angelina R; Ferrucci, Luigi; Zonderman, Alan B; Resnick, Susan M

    2013-04-01

    Alzheimer's disease (AD) neuropathology is found at autopsy in approximately 30% of cognitively normal older individuals. We examined whether personality traits are associated with such resilience to clinical dementia in individuals with AD neuropathology. Broad factors and specific facets of personality were assessed up to 28 years (mean 11 ± 7 years) before onset of dementia and up to 30 years (mean 15 ± 7 years) before death in a cohort (n = 111) evaluated for AD neuropathology at autopsy. Individuals with higher baseline scores on vulnerability to stress, anxiety, and depression (neuroticism: odds ratio, 2.0; 95% confidence interval, 1.2-3.5), or lower scores on order and competence (conscientiousness: odds ratio, 0.4; 95% confidence interval, 0.2-0.9) were less likely to remain asymptomatic in the presence of AD neuropathology. Neuroticism (r = 0.26), low agreeableness (r = -0.34), and some facets were also significantly associated with advanced stages of neurofibrillary tangles, but the associations between personality traits and risk of clinical dementia were mostly unchanged by controlling for the extent of neurofibrillary tangles and Aβ neuritic plaques. In sum, a resilient personality profile is associated with lower risk or delay of clinical dementia even in persons with AD neuropathology.

  14. FISH analysis of intrapulmonary malignant mesothelioma without a clinically detectable primary pleural lesion: an autopsy case.

    PubMed

    Hasegawa, Mizue; Sakai, Fumikazu; Sato, Akitoshi; Tsubomizu, Sayuri; Arimura, Ken; Katsura, Hideki; Koh, Eitetsu; Sekine, Yasuo; Wu, Di; Hiroshima, Kenzo

    2014-12-01

    Patients with malignant mesothelioma typically present with a pleural effusion or pleural thickening and masses. A rare autopsy case of mesothelioma presenting with multiple bilateral lung nodules without clinically detectable pleural lesions is presented. A definitive diagnosis of the video-assisted thoracic surgery specimen could not be made, though a pattern of fibrosis mimicking organizing pneumonia was identified. Despite corticosteroid therapy, follow-up chest computed tomography showed enlargement of multiple nodules accompanied by the appearance of pleural thickening and effusions. The patient died of respiratory failure 11 months after initial presentation. Autopsy and retrospective analysis of the video-assisted thoracic surgery specimen using a p16 fluorescence in situ hybridization assay showed p16 homozygous deletion. The final diagnosis was sarcomatoid mesothelioma, and the lung nodules were intrapulmonary metastases from a clinically undetectable pleural sarcomatoid mesothelioma. It is important both to consider the possibility of mesothelioma with unusual clinical, radiological and pathological presentations and to remember that p16 fluorescence in situ hybridization analysis can play an important role in the diagnosis of mesothelioma.

  15. Quantification of nucleic acid quality in postmortem tissues from a cancer research autopsy program

    PubMed Central

    Fan, Jun; Khanin, Raya; Sakamoto, Hitomi; Zhong, Yi; Michael, Chelsea; Pena, Derwin; Javier, Breanna; Wood, Laura D.; Iacobuzio-Donahue, Christine A.

    2016-01-01

    The last decade has seen a marked rise in the use of cancer tissues obtained from research autopsies. Such resources have been invaluable for studying cancer evolution or the mechanisms of therapeutic resistance to targeted therapies. Degradation of biomolecules is a potential challenge to usage of cancer tissues obtained in the post-mortem setting and remains incompletely studied. We analysed the nucleic acid quality in 371 different frozen tissue samples collected from 80 patients who underwent a research autopsy, including eight normal tissue types, primary and metastatic tumors. Our results indicate that RNA integrity number (RIN) of normal tissues decline with the elongation of post-mortem interval (PMI) in a tissue-type specific manner. Unlike normal tissues, the RNA quality of cancer tissues is highly variable with respect to post-mortem interval. The kinetics of DNA damage also has tissue type-specific features. Moreover, while DNA degradation is an indicator of low RNA quality, the converse is not true. Finally, we show that despite RIN values as low as 5.0, robust data can be obtained by RNA sequencing that reliably discriminates expression signatures. PMID:27602498

  16. 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.

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

    PubMed

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

    2013-01-01

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

  18. 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

  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. Prognostic Factors Related to Dementia with Lewy Bodies Complicated with Pneumonia: An Autopsy Study

    PubMed Central

    Manabe, Toshie; Mizukami, Katsuyoshi; Akatsu, Hiroyasu; Hashizume, Yoshio; Teramoto, Shinji; Nakamura, Seiji; Kudo, Koichiro; Hizawa, Nobuyuki

    2016-01-01

    Objective In patients demonstrating dementia with Lewy bodies (DLB), pneumonia is a common complication. However, the prognostic factors for the survival time in DLB with pneumonia have not been investigated by autopsy in patients with neuropathologically confirmed DLB. Methods We conducted a retrospective study of the medical and autopsy reports of 42 patients admitted to a Japanese hospital between 2005 and 2014. The patients were neuropathologically diagnosed as having DLB by post-mortem examinations. We analyzed the effects of various factors on the time from DLB onset to death. Results Thirty-nine of the 42 patients with DLB (92.9%) developed pneumonia during hospitalization. The median age at DLB onset was 78 years and the median time from DLB onset to death was 8 years. The Cox proportional hazard model demonstrated cerebral infarction [Hazard Ratio (HR), 2.36 (95% CI 1.12-4.96), p=0.023], muscle weakness [HR, 2.04 (0.95-4.39), p=0.067], male sex [HR, 2.84 (1.24-6.50), p=0.014], and age at onset (≥78 years.) [HR, 4.71 (1.82-12.18), p=0.001] to be prognostic factors for a shorter time from DLB onset to death. Conclusion Careful treatment of cerebral infarction and muscle weakness of the lower extremities is crucial for DLB patients with pneumonia, especially for those over 78 years of age, in order to maximize the patients' life expectancies. PMID:27725535

  1. Alobar holoprosencephaly with cyclopia - autopsy-based observations from one medical center.

    PubMed

    Swatek, Jarosław; Szumiło, Justyna; Burdan, Franciszek

    2013-11-01

    Holoprosencephaly, a major congenital malformation of the brain, consists in a complete or partial failure of the prosencephalon to divide into separate hemispheres. Alobar holoprosencephaly with cyclopia was analyzed on the basis of autopsy reports performed for hospitals admitting patients from the Lublin Region in Eastern Poland in the period of 20 years (1981-2000). The malformation was found in seven newborns - five girls, one boy and one child with sex not established due to agenesia of the genital organs, all autopsied in the years 1990-1999. According to clinical data, none of the mothers (age 24-39 years) was exposed to any prescribed or over-the-counter (OTC) drugs during pregnancy, but one was exposed to paints in early pregnancy. The proboscis was present in four of seven cases. Six of seven children displayed additional congenital malformations. In two cases intrapancreatic accessory spleen suggesting trisomy 13 was found. Alobar holoprosencephaly with cyclopia is a rare lethal congenital anomaly frequently accompanied by other malformations and characterized by large variations in incidence.

  2. 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.

  3. The clinical correlation of an autopsy study of recurrent colorectal cancer.

    PubMed Central

    Welch, J P; Donaldson, G A

    1979-01-01

    The complete autopsies of 145 patients dying of colorectal cancer are reviewed. Isolated local or distant metastases are infrequent, compared to disseminated disease. Solitary local recurrences are most common after resection of rectal tumors. Right colon tumors spread to local and distant sites in 90% of autopsies, and to distant sites alone in 10%. Rectal tumors spread locally only in 25% of cases, to distant site alone in 25%, and to both in 50%. Regardless of the origin of the primary tumor, the liver is the most common site of metastasis, followed by the regional lymph nodes and the lungs. Two-thirds of the patients with right colon lesions died of liver metastases, and three-quarters of those with rectal tumors succumbed to disseminated disease. The current curative and palliative treatment of recurrent colorectal cancer in clinical medicine by surgery, radiotherapy, and chemotherapy is reviewed. It is suggested that an understanding of the anatomic patterns of cancer recurrence will increase in importance as advances in the modalities of treatment are made, Images Fig. 1. Fig. 2. Fig. 3. PMID:443905

  4. Fatal water intoxication in a schizophrenic patient--an autopsy case.

    PubMed

    Hayashi, Takahito; Ishida, Yuko; Miyashita, Tomoko; Kiyokawa, Hikaru; Kimura, Akihiko; Kondo, Toshikazu

    2005-06-01

    We report a case of fatal water intoxication due to polydipsia. A 69-year-old schizophrenic male was found dead at his room of the hospital in which he had been admitted. Medico-legal autopsy was carried out to determine the cause of his death. The autopsy revealed no severe trauma leading him to the death. Internally, it was noticed that the stomach was vigorously expanded, including fluid contents. Intracardiac blood, being dark-red in color, seemed to be diluted. The both lungs ballooned aqueously, showing apparently edema. However, there was neither macroscopic nor histopathological lesion, being responsible for his death. Postmortem biochemical analyses revealed severe hyponatremia of 92 mEq/ml. In cases with short postmortem interval, serum sodium level almost similarly reflected antemortem level. According to his psychiatric doctor, he had been diagnosed as water intoxication due to polydipsia. Moreover, at 2 h before the discovery of his body, he had been found to drink much running water. It was concluded the cause of his death as fatal water intoxication.

  5. Visuospatial deficits predict rate of cognitive decline in autopsy-verified dementia with Lewy bodies.

    PubMed

    Hamilton, Joanne M; Salmon, David P; Galasko, Douglas; Raman, Rema; Emond, Jenn; Hansen, Lawrence A; Masliah, Eliezer; Thal, Leon J

    2008-11-01

    Dementia with Lewy bodies (DLB) is often characterized by pronounced impairment in visuospatial skills, attention, and executive functions. However, the strength of the phenotypic expression of DLB varies and may be weaker in patients with extensive concomitant Alzheimer's disease (AD). To determine whether strength of the DLB clinical phenotype impacts cognitive decline, visuospatial and language tests were retrospectively used to predict 2-year rate of global cognitive decline in 22 autopsy-confirmed DLB patients (21 with concomitant AD) and 44 autopsy-confirmed "pure" AD patients. Generalized estimating equations (GEE) revealed a significant interaction such that poor baseline performances on tests of visuospatial skills were strongly associated with a rapid rate of cognitive decline in DLB but not AD (p < .001). No effect of confrontation naming was found. DLB patients with poor visuospatial skills had fewer neurofibrillary tangles and were more likely to experience visual hallucinations than those with better visuospatial skills. These results suggest that the severity of visuospatial deficits in DLB may identify those facing a particularly malignant disease course and may designate individuals whose clinical syndrome is impacted more by Lewy body formation than AD pathology.

  6. Autopsy case of Dubin-Johnson syndrome with pneumonia and abetalipoproteinemia-like lipid profile.

    PubMed

    Kaneko, Mitsunobu; Ohni, Mitsuo; Sugiyama, Youichi; Mizukawa, Shinjirou; Toba, Kenji; Sakamoto, Atsuhiko; Hata, Yoshiya

    2006-06-01

    We report the autopsy of a 79-year-old Japanese woman with Dubin-Johnson syndrome accompanied by pneumonia, an abetalipoproteinemia-like lipid profile and acanthocytosis. On admission, physical examination of the patient revealed malnutrition. Blood tests revealed marked inflammatory changes and mild liver dysfunction. Chest X-ray indicated bilateral pneumonia. Total cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels were 89 mg/dL, 5 mg/dL and 6 mg/dL, respectively. Peripheral blood smears revealed numerous acanthocytes. Despite the administration of antibiotics and nutritional support, the patient died. Autopsy revealed a black liver, atrophy of fat tissue on the mesentery, and pneumonia with bilateral pleural effusion. We believe that the abetalipoproteinemia-like lipid profiles in this case were caused by malnutrition and the inflammatory changes rather than the direct effects of Dubin-Johnson syndrome. We base this conclusion on the following three findings: 1) the patient's lipid profile before hospitalization was in the normal range, 2) her serum LDL cholesterol and triglyceride levels gradually increased after nutritional support began, and 3) blood tests revealed marked inflammatory changes (C-reactive protein 9.0 mg/dL; interleukin-6 16.4 pg/mL). This case provides important information that enhances our understanding of lipid metabolism under conditions of malnutrition and inflammation.

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

    PubMed

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

    2012-02-10

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

  8. 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…

  9. Perivascular Adipose Tissue Inflammation and Coronary Artery Disease: An Autopsy Study Protocol

    PubMed Central

    Farias-Itao, Daniela Souza; Pasqualucci, Carlos Augusto; Nishizawa, Aline; Silva, Luiz Fernando Ferraz; Campos, Fernanda Marinho; da Silva, Karen Cristina Souza; Leite, Renata Elaine Paraizo; Grinberg, Lea Tenenholz; Ferretti-Rebustini, Renata Eloah Lucena; Jacob Filho, Wilson

    2016-01-01

    Background Perivascular adipose tissue (PAT) inflammation may have a role in coronary artery disease (CAD) pathophysiology. However, most evidence has come from samples obtained during surgical procedures that may imply in some limitations. Moreover, the role of B lymphocytes and inflammation in PAT that is adjacent to unstable atheroma plaques has not been investigated in humans using morphometric measurements. Objective The objective of this study is to investigate the inflammation in PAT, subcutaneous, and perirenal adipose tissues (SAT and PrAT) among chronic CAD, acute CAD, and control groups in an autopsy study. Methods Heart, SAT, and PrAT samples are collected from autopsied subjects in a general autopsy service, with the written informed consent of the next-of-kin (NOK). Sociodemographic and clinical data are obtained from a semistructure interview with the NOK. Coronary arteries are dissected and PAT are removed. Sections with the greatest arterial obstruction or unstable plaques, and the local with absence of atherosclerosis in all coronary arteries are sampled. PAT are represented adjacent to these fragments. Adipose tissues are fixed in 4% buffered paraformaldehyde solution and analyzed immunohistochemically for macrophages (CD68), macrophage polarization (CD11c for proinflammatory and CD206 for anti-inflammatory), B lymphocytes (CD20), and T lymphocytes (CD3). Slides will be scanned, and inflammatory cells will be quantified in 20 random fields. Participants will be categorized in CAD groups, after morphometric measurement of arterial obstruction and plaque composition analysis in accordance with American Heart Association classification. Three study groups will be investigated: acute CAD (at least one unstable plaque); chronic CAD (≥50% arterial obstruction); and controls (<50% arterial obstruction). Inflammatory cells in PAT, SAT, and PrAT will be counted and compared between groups using multivariate linear regression, adjusted for age, body mass

  10. Characterization of RNA isolated from eighteen different human tissues: results from a rapid human autopsy program.

    PubMed

    Walker, Douglas G; Whetzel, Alexis M; Serrano, Geidy; Sue, Lucia I; Lue, Lih-Fen; Beach, Thomas G

    2016-09-01

    Many factors affect the integrity of messenger RNA from human autopsy tissues including postmortem interval (PMI) between death and tissue preservation and the pre-mortem agonal and disease states. In this communication, we describe RNA isolation and characterization of 389 samples from 18 different tissues from elderly donors who were participants in a rapid whole-body autopsy program located in Sun City, Arizona ( www.brainandbodydonationprogram.org ). Most tissues were collected within a PMI of 2-6 h (median 3.15 h; N = 455), but for this study, tissue from cases with longer PMIs (1.25-29.25 h) were included. RNA quality was assessed by RNA integrity number (RIN) and total yield (ng RNA/mg tissue). RIN correlated with PMI for heart (r = -0.531, p = 0.009) and liver (r = -558, p = 0.0017), while RNA yield correlated with PMI for colon (r = -485, p = 0.016) and skin (r = -0.460, p = 0.031). RNAs with the lowest integrity were from skin and cervix where 22.7 and 31.4 % of samples respectively failed to produce intact RNA; by contrast all samples from esophagus, lymph node, jejunum, lung, stomach, submandibular gland and kidney produced RNA with measurable RINs. Expression levels in heart RNA of 4 common housekeeping normalization genes showed significant correlations of Ct values with RIN, but only one gene, glyceraldehyde-3 phosphate dehydrogenase, showed a correlation of Ct with PMI. There were no correlations between RIN values obtained for liver, adrenal, cervix, esophagus and lymph node and those obtained from corresponding brain samples. We show that high quality RNA can be produced from most human autopsy tissues, though with significant differences between tissues and donors. The RNA stability and yield did not depend solely on PMI; other undetermined factors are involved, but these do not include the age of the donor.

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

    PubMed Central

    2011-01-01

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

  12. [Causes of death among patients with acquired immunodeficiency syndrome autopsied at the Tropical Medicine Foundation of Amazonas].

    PubMed

    Souza, Sílvia Leopoldina Santos de; Feitoza, Pablo Vinícius Silveira; Araújo, José Ribamar de; Andrade, Rosilene Viana de; Ferreira, Luiz Carlos de Lima

    2008-01-01

    The aim of this study was to investigate the causes of death among 129 AIDS patients that were autopsied at the Tropical Medicine Foundation of Amazonas between 1996 and 2003. The degree of concordance between the autopsy diagnoses and the clinical diagnoses was observed. The disease that most frequently caused death was tuberculosis (28%), followed by bacterial pneumonia (17%), histoplasmosis (13%), toxoplasmosis (10%), pneumocystosis (8%), cryptococcosis (5%), bacterial sepsis (4%) and other causes (15%). The concordance between the clinical diagnosis before death and the autopsy was 51.9%. The main organ involved was the lungs (82.2%). The length of survival from the time of the laboratory diagnosis to death ranged from one month to 120 months. The mean length of survival was 15 days and 56% died less than one month after the diagnosis, while 15 patients died on the same day that they were diagnosed. These results show the importance of autopsies in elucidating the causes of death among AIDS patients.

  13. 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…

  14. Intractable hiccup caused by medulla oblongata lesions: a study of an autopsy patient with possible neuromyelitis optica.

    PubMed

    Kobayashi, Zen; Tsuchiya, Kuniaki; Uchihara, Toshiki; Nakamura, Ayako; Haga, Chie; Yokota, Osamu; Ishizu, Hideki; Taki, Kazuhiro; Arai, Tetsuaki; Akiyama, Haruhiko; Mizusawa, Hidehiro

    2009-10-15

    We report the first autopsy verification of medulla oblongata lesions involving bilateral nucleus tractus solitarius (NTS) as a cause of intractable hiccup in an autopsy patient. The female patient first developed pain and weakness in the lower limbs and urinary incontinence at age 48, and was given a diagnosis of myelitis. Intractable hiccup was accompanied by urinary retention on the third attack. She died of respiratory failure when the fifth attack occurred at age 51. Autopsy disclosed severe involvement of the medulla oblongata and entire spinal cord. Optic nerve lesions were also identified unexpectedly. Dual involvement of the optic nerve and spinal cord, necrotic spinal cord lesions involving not only myelin but also neurons and axon, and marked extension of the spinal cord lesions in both the longitudinal and transverse directions suggested the diagnosis of neuromyelitis optica rather than multiple sclerosis. Although animal experiments have shown that NTS is a critical structure in the hiccup reflex, we demonstrated for the first time the involvement of the NTS in an autopsy patient with intractable hiccup.

  15. Understanding Suicide in Socially Vulnerable Contexts: Psychological Autopsy in a Small Town in Mexico.

    PubMed

    Chávez-Hernández, Ana-María; Macías-García, Luis-Fernando

    2016-02-01

    In Mexico, suicides are increasing in certain latitudes where local rates have grown to levels of alert; suicide is also the second most common cause of death for the group aged 15 to 19. The psychological autopsy method was utilized to uncover and analyze common factors in all of the registered suicides within 2011 and 2012 in a small town of the state of Guanajuato, located in the center of Mexico. A total of nine decedents were analyzed, and 22 interviews were conducted. The most salient factors were as follows: poverty, financial stress, substance abuse, low levels of education, conflictive relationships, and a poor handling of emotions. The concepts of social exclusion and vulnerability were employed to analyze suicides as symptoms of a much deeper problem of this country, suggesting that anomie and social malady are nowadays important suicidal factors, mostly for children and young people.

  16. 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.

  17. 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.

  18. 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

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

    PubMed

    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.

  20. Multiple primary intracranial tumors and association of intra- and extracranial tumors. An autopsy study.

    PubMed

    Tiszlavicz, L

    1993-01-01

    In 37504 autopsies performed during the last 3 decades at the Department of Pathology of Albert Szent-Györgyi Medical University (Szeged, Hungary) gliomas were found in 498 cases. These gliomas were associated with other types of intra- or extracranial tumors in 1.2-3.2% of the cases. Despite the male predominance observed in other types of multiple tumors, the multiple intracranial tumors and the intracranial tumors associated with extracranial malignancies were more frequent in females (possible role of hormonal influences). A relatively frequent association of various intracranial tumors with gastrointestinal carcinomas and in one quarter of the cases with extracranial benign tumors indicates that genetic factors may be involved in the pathomechanism.

  1. (/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.

  2. Culture, risk factors and suicide in rural China: a psychological autopsy case control study

    PubMed Central

    Zhang, J.; Conwell, Y.; Zhou, L.; Jiang, C.

    2009-01-01

    Objective Previous research on sociocultural factors for Chinese suicide have been basically limited to single case studies or qualitative research with ethnographic methodology. The current study examines the major risk factors and some cultural uniqueness related to Chinese rural suicide using a quantitative design. Method This is a case control study with 66 completed suicides and 66 living controls obtained from psychological autopsy interviews in rural China. Results Both bivariate analyses and the multiple regression model have found that the Chinese rural suicide patterns are basically similar to those in most other cultures in the world: strong predictors of rural Chinese suicide are the psychopathological, psychological, and physical health variables, followed by social support and negative and stressful life events. Other significant correlates include lower education, poverty, religion, and family disputes. Conclusion Culture has an important impact on suicide patterns in a society. PMID:15521827

  3. 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.

  4. Sudden Death Due to Unusual Complication of Takayasu Arteritis: An Autopsy Case.

    PubMed

    Jedidi, Maher; Chkirbene, Youssef; Abdessayed, Nihed; Masmoudi, Tasnim; Mahjoub, Mohamed; Mlayeh, Souheil; Dhiab, Mohamed Ben; Souguir, Mohamed Kamel; Yacoubi, Mohamed Taher

    2017-01-18

    Takayasu arteritis is an uncommon inflammatory disease with usually a good prognosis. However, sometimes, the evolution can be fatal essentially by a coronary arteries involvement. We present a case of a 19-year-old woman who died suddenly from cardiogenic shock complicating an unknown Takayasu arteritis.At the autopsy, the aorta showed a significant thickening of the wall. The coronary arteries were slightly thickened and did not show any occlusion. Microscopic examination of the aorta showed an abundant granulomatous and a lymphoplasmacytic infiltrate. Microscopic sections of other internal organs showed signs of cardiac hypertrophy and an extensive edema of the lung. Death was attributed to acute heart failure complicating a supravalvular aortic stenosis secondary to unknown Takayasu arteritis.Takayasu arteritis can be life-threatening by an occlusion of the ascending aorta and its major branches, without any coronary arteries involvement.

  5. 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.

  6. Risk Factors for Farmers' Suicides in Central Rural India: Matched Case–control Psychological Autopsy Study

    PubMed Central

    Bhise, Manik Changoji; Behere, Prakash Balkrushna

    2016-01-01

    Background: Despite more than two decades since recognition of suicides by farmers in India, systematic studies comparing various risk factors are lacking. This is major hurdle for the formulation of strategies for farmers' suicide prevention. Objective: To identify socioeconomic and psychological risk factors and their relative contribution in suicides by farmers. Materials and Methods: A matched case–control psychological autopsy was done on 98 farmers' suicide victims and 98 controls in Central India. Results: Economic problems, psychiatric illness, and stressful life events were found to be important contributors to farmers' suicides. Important economic risk factors were procurement of debt, especially from multiple sources and for nonagricultural reasons and leasing out farms. Psychiatric illness was present significantly in higher proportion among cases than controls. Crop failure, interpersonal problems, medical illness, and marriage of female family member were significant stressful life events. Conclusions: There are socioeconomic and psychological risk factors for suicide by farmers which can be targets of prevention policy. PMID:28031593

  7. Bilateral congenital adrenal agenesis: a rare disease entity and not a result of poor autopsy technique.

    PubMed

    D'Arcy, Colleen; Pertile, Mark; Goodwin, Tess; Bittinger, Sophie

    2014-01-01

    Congenital adrenal agenesis is an extremely rare condition wherein the adrenal glands fail to develop. The absence of adrenal tissue results in the complete absence of hormones produced in the adrenal cortex (cortisol, aldosterone) and medulla (catecholamines), and is not compatible with postnatal life without artificial hormone replacement therapy. To date, 9 cases of adrenal agenesis have been reported, many of which are associated with additional congenital anomalies. Most cases were not detected on antenatal imaging and were detected incidentally at postmortem examination. We present a case of adrenal agenesis, detected incidentally at postmortem examination after termination of pregnancy for suspected fetal hydrops, and review the heterogeneous phenotype of this condition with associated abnormalities and molecular genetics. This case reinforces the role of the perinatal autopsy to investigate cause of perinatal mortality, allowing correlation of pathology with antenatal imaging findings and clinical details.

  8. Traumatic asphyxial deaths in car crush: Report of 3 autopsy cases.

    PubMed

    Pathak, Hrishikesh; Borkar, Jaydeo; Dixit, Pradeep; Shrigiriwar, Manish

    2012-09-10

    Traumatic asphyxia is a rare syndrome due to compression of thorax, abdomen or both. The diagnosis of traumatic asphyxia is based on typical findings consisting of cervico-facial congestion with swelling, multiple petechial hemorrhages in skin and conjunctiva with a history of traumatic compression. The authors report three cases of traumatic asphyxia in car crash to illustrate few unusual findings along with the typical autopsy findings. All three cases showed the typical findings of traumatic asphyxia. Regarding unusual findings, blisters containing hemorrhagic fluid were observed in two cases over areas subjected to traumatic compression. One case showed the peculiar skin pattern in the form of absent congestion corresponding to the tight-fitting strap of banyan. Subcutaneous emphysema was noted in two cases in presence of intact visceral pleura. These unusual findings could be used as additional markers of traumatic asphyxia in conjunction with characteristic features to support the diagnosis of traumatic asphyxia.

  9. Autopsy case of undiagnosed gangliocytoma in the medulla oblongata complicated with cerebral palsy.

    PubMed

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

    2016-03-01

    A Japanese man in his 30s who had congenital cerebral palsy was found unresponsive in bed. His death was confirmed after resuscitation attempts. He had a history of occasional falling (despite the use of walking sticks and a wheelchair) owing to a slowly progressive gait disturbance, and had a medical examination without full neurological re-examination. Autopsy revealed gangliocytoma in the medulla oblongata, which was diagnosed as the cause of death. Although gangliocytoma is a well-differentiated benign tumor, the almost total replacement of the medulla oblongata by the tumor cells was assumed to result in ataxia via the olivocerebellar tract and secondary cerebellar atrophy, followed by central hypoventilation and death of the patient. The symptoms caused by gangliocytoma may be overlooked owing to long-standing cerebral palsy.

  10. 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

  11. An autopsy case of an aged patient with spinocerebellar ataxia type 2.

    PubMed

    Ishida, Chiho; Komai, Kiyonobu; Yonezawa, Kohei; Sakajiri, Ken-Ichi; Nitta, Eishun; Kawashima, Atsuhiro; Yamada, Masahito

    2011-10-01

    We report the case of a woman who developed limb clumsiness in her fifties and gait disturbance in her sixties. She was bedridden after bone fractures at age 75 and showed disorientation, slow eye movement, gaze palsy, ataxic speech, muscle atrophy and weakness, and areflexia with pathological reflex. She died of respiratory failure at age 85. This patient was diagnosed genetically as having spinocerebellar ataxia type 2 (SCA2), and the number of expanded CAG repeats was 41. At autopsy, the brain weighed 965 g, and the brainstem, cerebellum, frontal convexity and spinal cord were atrophic. Neuronal loss and gliosis were severe in the pontine nucleus, inferior olivary nucleus, cerebellar cortex, gracile and cuneate nuclei and moderate in the substantia nigra, cerebellar dentate nucleus, anterior horns of the spinal cord and dorsal root ganglia. Axonal loss was observed in the middle and inferior cerebellar peduncles, pyramidal tract and posterior column of the spinal cord. Senile plaques and neurofibrillary tangles (NFTs) were diffusely found in the cerebrum (plaque stage C; NFT stage IV). Expanded polyglutamine-immunoreactive inclusions in the neuronal cytoplasm were widely distributed in the CNS, and neuronal intranuclear inclusions were observed in the pontine nucleus and cerebral cortex. This patient in this autopsy case is a late-onset and aged patient with SCA2, and this is the first report of SCA2 combined with Alzheimer's disease (AD) pathology. Neuropathological findings in this patient, except for AD pathology, were consistent with those of reported SCA2 cases. However, the olivo-ponto-cerebellar system of this patient was relatively preserved and the cerebellar dentate nucleus was more involved as compared with previously reported cases. These results suggest that age at onset or the number of CAG repeat expansions could correlate with the distribution pattern of SCA2 neurodegeneration.

  12. Hippocampal phospho-tau/MAPT neuropathology in the fornix in Alzheimer disease: an immunohistochemical autopsy study.

    PubMed

    Plowey, Edward D; Ziskin, Jennifer L

    2016-10-28

    Whereas early Alzheimer disease (AD) neuropathology and mild cognitive impairment are relatively common in aging, accurate prediction of patients that will progress to dementia requires new biomarkers. Recently, substantial work has focused on phospho-tau/MAPT (p-MAPT) neuropathology since its regional propagation correlates with the degree of cognitive impairment in AD. Recent diffusion tensor imaging studies in AD suggest that increased diffusion in the fornix secondary to p-MAPT-related axonal injury could serve as a predictive biomarker of the risk of disease progression. However, our knowledge of p-MAPT neuropathology in the fornix is limited. To address this gap in knowledge, we examined p-MAPT neuropathology in the fornix and basal forebrain nuclei via AT8 immunohistochemistry in 39 brain autopsies spanning the spectrum of AD neuropathologic changes. We found that the fornix and its precommissural efferent target nuclei (septum and nucleus accumbens) demonstrated neuronal and thread-like p-MAPT neuropathology only in National Institute on Aging/Alzheimer Association (NIA/AA) stages B2 and B3 of neurofibrillary degeneration, consistent with involvement after (and propagation from) the hippocampal formation. Interestingly, although tau astrogliopathy was frequently observed in the mammillary bodies in stage B2, neuronal tauopathy was not observed in the postcommissural targets (mammillary bodies and anterior thalamic nucleus) until stage B3. Tauopathy in the nucleus basalis of Meynert was strongly correlated with p-MAPT-positive axons in the fornix, suggesting that projections to the hippocampus also likely contribute to fornix tauopathy. Our cross-sectional autopsy findings indicate that the fornix is involved by p-MAPT neuropathology secondary to hippocampal involvement by AD neuropathology. Furthermore, our findings are compatible with the goal of in vivo detection of p-MAPT-related axonal pathology in the fornix in AD as a possible biomarker of p

  13. 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

  14. 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.

  15. 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

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

    PubMed Central

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

    2012-01-01

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

  17. Frequency and nature of testicular and paratesticular lesions in forensic autopsies.

    PubMed

    de la Grandmaison, Geoffroy Lorin; Marchaut, Jéhanne; Watier, Laurence; Médiouni, Zakia; Charlier, Philippe

    2013-10-01

    The aim of our study was to determine the frequency and nature of testicular and paratesticular lesions in forensic autopsies. A retrospective study was carried out on 495 adult male cases that underwent forensic autopsy from January 2008 to December 2011 in our Department. For each case, the following parameters were reported: age, body mass index, nature of testicular and paratesticular lesions, associated lesions in external genitalia, testicle weight, cause of death, manner of death, resuscitation attempts and prior medical history. Mean age of the studied population was 47.8 years (range 18-96). Mean body mass index was 25.3 kg/m(2) (range 15-46.2). Testicular lesions and/or paratesticular were found in 16.4% of the cases (n = 81). The most frequent lesions were, respectively, testicular atrophy (n = 38) and trauma (n = 28). In three cases showing traumatic lesions, associated traumatic lesions were found in external genitalia. Most frequent cause of death was blunt trauma (19.9% of the cases). Manner of death most frequently associated with testicular trauma was, respectively, road traffic accident (n = 11) and suicidal fall (n = 6). Mean testicular weight was, respectively, 17.9 g for the right and 20.8 g for the left (range 2-38). Atrophy was associated with testicular weight less than 10 g. A significant association between testicular atrophy and age was found, the risk of atrophy increasing quite linearly with age. No significant statistical link between prior medical history and testicular pathology was found. There was also no influence of body mass index. Resuscitation attempts were not statistically associated with testicular traumatic lesions.

  18. Verbal autopsy-assigned causes of death among adults being investigated for TB in South Africa

    PubMed Central

    Maraba, Noriah; Karat, Aaron S; McCarthy, Kerrigan; Churchyard, Gavin J; Charalambous, Salome; Kahn, Kathleen; Grant, Alison D; Chihota, Violet

    2016-01-01

    Background Adults being investigated for TB in South Africa experience high mortality, yet causes of death (CoD) are not well defined. We determined CoD in this population using verbal autopsy (VA), and compared HIV- and TB-associated CoD using physician-certified verbal autopsy (PCVA) and InterVA-4 software. Methods All contactable consenting caregivers of participants who died during a trial comparing Xpert MTB/RIF to smear microscopy were interviewed using the WHO VA tool. CoD were assigned using PCVA and InterVA-4. Kappa statistic (K) and concordance correlation coefficient (CCC) were calculated for comparison. Results Among 231 deaths, relatives of 137 deceased were interviewed. Of the 137 deceased 76 (55.4%) were males, median age 41 years (IQR 33–50). PCVA assigned 70 (51.1%) TB immediate CoD (44 [62.8%] pulmonary TB; 26 [37.1%] extra-pulmonary TB); 21 (15.3%) HIV/AIDS-related; and 46 (33.5%) other CoD. InterVA-4 assigned 48 (35.0%) TB deaths; 49 (35.7%) HIV/AIDS-related deaths; and 40 (29.1%) other CoD. Agreement between PCVA and InterVA-4 CoD was slight at individual level (K=0.20; 95% CI 0.10–0.30) and poor at population level (CCC 0.67; 95% CI 0.38–0.99). Conclusions TB and HIV are leading CoD among adults being investigated for TB. PCVA and InterVA agreement at individual level was slight and poor at population level. VA methodology needs further development where TB and HIV are common. PMID:27794093

  19. GSK3β Interactions with Amyloid Genes: An Autopsy Verification and Extension.

    PubMed

    Hohman, Timothy J; Chibnik, Lori; Bush, William S; Jefferson, Angela L; De Jaeger, Phillip L; Thornton-Wells, Tricia A; Bennett, David A; Schneider, Julie A

    2015-10-01

    Glyocogen synthase kinase 3 (GSK3) plays an important role in the pathophysiology of Alzheimer's disease (AD) through the phosphorylation of tau. Recent work has suggested that GSK3β also plays a role in the amyloid pathway of AD through genetic interactions with APP and APBB2 on in vivo measures of amyloid. This project extends the previously identified genotype interactions to an autopsy measure of amyloid, while also testing the same interactions leveraging gene expression data quantified in the prefrontal cortex. 797 participants (251 cognitively normal, 196 mild cognitive impairment, and 350 Alzheimer's disease) were drawn from the Religious Orders Study and Rush Memory and Aging Project. A mean score of amyloid load was calculated across eight brain regions, gene expression levels from frozen sections of the dorsolateral prefrontal cortex were quantified using RNA amplification, and expression signals were generated using Beadstudio. Three SNPs previously identified in genetic interactions were genotyped using the Illumina 1M genotyping chip. Covariates included age, sex, education, and diagnosis. We were able to evaluate 2 of the 3 previously identified interactions, of which the interaction between GSK3β (rs334543) and APBB2 (rs2585590) was found in this autopsy sample (p = 0.04). We observed a comparable interaction between GSK3β and APBB2 when comparing the highest tertile of gene expression to the lowest tertile, t(1) = -2.03, p = 0.043. These results provide additional evidence of a genetic interaction between GSK3β and APBB2 and further suggest that GSK3β is involved in the pathophysiology of both of the primary neuropathologies of Alzheimer's disease.

  20. The influence of gender and of AIDS on the immunity of autopsied patients' esophagus.

    PubMed

    Rocha, Laura Penna; de Melo E Silva, Ana Teresa; Gomes, Nayara Cândida; Faria, Humberto Aparecido; Silva, Renata Beatriz; Olegário, Janaínna Grazielle Pacheco; Corrêa, Rosana Rosa Miranda; de Paula Antunes Teixeira, Vicente; Cavellani, Camila Lourencini

    2011-05-01

    Previous studies have shown that males who have AIDS are more frequently affected by infectious diseases than females. The esophagus is the organ in the digestive tube that is more commonly affected by opportunistic infections during the syndrome. The aim of this study was to assess the influence of AIDS and of gender on local immunity of the esophageal epithelium. Fragments of the esophagus from 29 autopsied women and 37 autopsied men were collected at a university hospital from 1980 to 2009 and were divided in groups with and without AIDS. The IgA-, IgG-, and IgM-positive cells and Langerhans cells (LCs) were immunostained, respectively, with anti-IgA, anti-IgG, anti-IgM, and anti-S100. The software Image J was used to measure the esophageal epithelium and to count the epithelium cellular layers. Patients with AIDS, apart from gender, showed an increase in IgA-, IgG-, and IgM-positive cells and a reduction of Langerhans cells, in thickness and in number of cellular layers in the esophageal epithelium. However, among individuals with AIDS, men presented lower secretory expression of IgA-, IgG-, and IgM-positive cells than women and more intense reduction of LCs. Women have naturally presented better local esophageal immunity than men. Although AIDS possibly causes immunological and morphological alterations in the esophageal epithelium in both genders, women have better esophageal immunity, which may explain a greater frequency of hospital admissions due to infection of men with AIDS when compared with women.

  1. 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.

  2. Limitations of cadaveric organ donation on judicial cases and problems confronted in autopsy: Istanbul data in comparative perspective.

    PubMed

    Arslan, M N; Esen Melez, I; Melez, D O; Cavlak, M; Gur, A

    2014-04-01

    Organ transplantation is one of the most important services of modern medicine to the humanity. In judicial death cases the interaction between judicial needs and transplantation needs is inevitable and both should be provided in a short time before the decomposition of the body. Thus, the description of this interaction and the algorithm which should be carried out to manage these cases are important. Aim of this study is to determine the problems confronted in forensic autopsies and to determine what to do for both judicial processes' and cadaveric organ donations' not becoming limited due to each other. With these aims, autopsy case archive of the Council of Forensic Medicine Istanbul Morgue Department was reviewed, between the years 2009 and 2011, to reveal the number of organ donors among autopsy cases and also to find out the judicial problems confronted during autopsies. Among 12,016 judicial death cases referred to Istanbul Morgue Department in 3 years, 35 cases were found to have undergone cadaveric solid organ harvesting procedure and 307 cases cornea-only harvesting procedure. Manner of deaths for organ donor cases were blunt trauma due to traffic accident in 20 cases, firearm injury in 3 cases, stabbing in 2 cases, suspicious criminal battery in 4 cases and fatal falls in 5 cases. Only 1 case was suspected to have died due to high dose insulin administration. Through the whole data presented in this study, it can be concluded that consulting with the Forensic Medicine Expert not only for the autopsies but also during the clinical process of a judicial case, who is a candidate to be an organ donor, is absolutely important. The early contribution of the Forensic Medicine Expert would provide help to plan both the judicial process and the transplantation process which needs urgent decisions. A Forensic Medicine Expert may be an organ harvest team member performing initial investigations on the cause of death and collecting some of the toxicological

  3. Marks of autopsy and identification of victims of human rights violations exhumed from cemeteries: the case of the Spanish Civil War (1936-1939).

    PubMed

    Ríos, Luis; Martínez, Berta; García-Rubio, Almudena; Herrasti, Lourdes; Etxeberria, Francisco

    2014-09-01

    The presence of autopsy marks in human skeletal remains indicates a medicolegal procedure related to ascertaining the cause and manner of death. We present here four cases where signs of autopsy were observed in the remains recovered from mass graves and cemeteries of prisoners from the Spanish Civil War (1936-1939), victims of extrajudicial executions, and of death in prison, respectively. With respect to the former, historical evidence indicate that during the first weeks after the coup, official removal of cadavers and autopsy procedures were carried out to the first victims of extrajudicial killings, whose corpses were found abandoned in the road. Once the civil war was established and systematic extrajudicial killings were systematic, official military orders were issued to stop standard forensic proceedings. Therefore, autopsy marks observed in the remains exhumed from mass graves located in cemeteries may be indicative of an earlier chronology of the killings, and this information proved to be relevant for the identification process in one of the cases presented. In a cemetery of political prisoners, autopsy signs were also observed in two skeletal remains and in the official records of two prisoners, a corroboration of information also relevant for the identification process. These findings indicate that autopsy marks can be found in the remains of victims of human rights violations exhumed from cemeteries. Skeletal and archival information could be useful for the identification process in other cases of large-scale violence, where the first victims of extrajudicial executions were buried unidentified in cemeteries after autopsy procedures.

  4. 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

  5. An Autopsy Case of Acute Massive Hematochezia Caused by Superior Mesenteric Vein Thrombosis: A First Report in Forensic Medicine.

    PubMed

    Watanabe, Mayumi; Unuma, Kana; Makino, Yohsuke; Noritake, Kanako; Yamada, Atsushi; Iwase, Hirotaro; Uemura, Koichi

    2016-01-01

    Superior mesenteric vein thrombosis (SMVT) is an uncommon cause of intestinal ischemia and massive gastrointestinal bleeding. This report describes a man with alcoholic liver cirrhosis, who died of massive hematochezia due to SMVT. A medicolegal autopsy disclosed a thrombus at the superior mesenteric vein and hemorrhagic infarction of the bowel wall, an area also within the territory of the superior mesenteric vein. Liver cirrhosis, an enlarged spleen, and esophageal varices without rupture were also observed, but ulcers and variceal bleeding were not. Other organs showed no significant findings. His blood alcohol level was 0.14% w/v. Thus, this man died from severe hematochezia associated with SMVT due to liver cirrhosis and alcohol dehydration, which can lead to coagulopathy and rapid progress of thrombus formation. This is the first report on an alternate cause for massive gastrointestinal hemorrhage with a cirrhotic patient in a forensic autopsy.

  6. Sudden unexpected deaths in different age groups at Ramathibodi Hospital, Bangkok, Thailand: a retrospective autopsy study during 2003-2007.

    PubMed

    Udnoon, Jitta; Chirachariyavej, Thamrong; Peonim, Vichan

    2009-01-01

    A sudden unexpected death is considered one type of medico-legal death in Thailand. In some studies, it comprises up to 50-60% of all medico-legal deaths. In this retrospective study, data were collected from 1,460 cases of sudden unexpected deaths, 39.9% of all deaths in which a medico-legal autopsy had been carried out. The study was conducted over a 5-year period from January 2003 to December 2007. There were 1,009 males and 451 females (M:F ratio = 2.2:1). The mean age was 55.3+/-0.98 years. The peak age group was the 46-60 years accounting for 28.2% of cases. The most common cause of death in all age groups was coronary atherosclerosis. Understanding epidemiological autopsy data is vital for determining the characteristics of the population involved.

  7. One small scan for radiology, one giant leap for forensic medicine - Post-mortem imaging replaces forensic autopsy in a case of traumatic aortic laceration.

    PubMed

    Ruder, Thomas D; Hatch, Gary M; Thali, Michael J; Fischer, Nadja

    2011-01-01

    The questions of cause and manner of death are the most pressing ones in any forensic investigation. Traditionally, autopsy is the means to provide answers to these questions and despite the increasing use of CT and MR in the post-mortem setting, imaging has usually been an adjunct to forensic autopsy. Here we describe a case where post-mortem CT and MR were performed instead of autopsy, at the request of the responsible public prosecutor. The forensic conclusions derived from imaging, including cause and manner of death were accepted by the legal authorities, thereby setting precedence for future cases. This case represents a landmark in forensic medicine and is another step toward the full realization of minimally invasive forensic autopsy.

  8. Validity of a Minimally Invasive Autopsy for Cause of Death Determination in Adults in Mozambique: An Observational Study

    PubMed Central

    Castillo, Paola; Martínez, Miguel J.; Ussene, Esperança; Jordao, Dercio; Lovane, Lucilia; Ismail, Mamudo R.; Carrilho, Carla; Lorenzoni, Cesaltina; Ferreira, Luiz; Lacerda, Marcus; Mandomando, Inacio; Vila, Jordi; Munguambe, Khátia; Maixenchs, Maria; Quintó, Llorenç; Macete, Eusebio; Alonso, Pedro; Bassat, Quique; Menéndez, Clara; Ordi, Jaume

    2016-01-01

    Background There is an urgent need to identify tools able to provide reliable information on the cause of death in low-income regions, since current methods (verbal autopsy, clinical records, and complete autopsies) are either inaccurate, not feasible, or poorly accepted. We aimed to compare the performance of a standardized minimally invasive autopsy (MIA) approach with that of the gold standard, the complete diagnostic autopsy (CDA), in a series of adults who died at Maputo Central Hospital in Mozambique. Methods and Findings In this observational study, coupled MIAs and CDAs were performed in 112 deceased patients. The MIA analyses were done blindly, without knowledge of the clinical data or the results of the CDA. We compared the MIA diagnosis with the CDA diagnosis of cause of death. CDA diagnoses comprised infectious diseases (80; 71.4%), malignant tumors (16; 14.3%), and other diseases, including non-infectious cardiovascular, gastrointestinal, kidney, and lung diseases (16; 14.3%). A MIA diagnosis was obtained in 100/112 (89.2%) cases. The overall concordance between the MIA diagnosis and CDA diagnosis was 75.9% (85/112). The concordance was higher for infectious diseases and malignant tumors (63/80 [78.8%] and 13/16 [81.3%], respectively) than for other diseases (9/16; 56.2%). The specific microorganisms causing death were identified in the MIA in 62/74 (83.8%) of the infectious disease deaths with a recognized cause. The main limitation of the analysis is that both the MIA and the CDA include some degree of expert subjective interpretation. Conclusions A simple MIA procedure can identify the cause of death in many adult deaths in Mozambique. This tool could have a major role in improving the understanding and surveillance of causes of death in areas where infectious diseases are a common cause of mortality. PMID:27875530

  9. Autopsy of Adult Patients Deceased in an Academic Hospital: Considerations of Doctors and Next-of-Kin in the Consent Process

    PubMed Central

    Weustink, Annick C.; Hunink, M. G. Myriam; Oosterhuis, J. Wolter

    2016-01-01

    Introduction Hospital autopsies, vanishing worldwide, need to be requested by clinicians and consented to by next-of-kin. The aim of this prospective observational study was to examine how often and why clinicians do not request an autopsy, and for what reasons next-of-kin allow, or refuse it. Methods Clinicians at the Erasmus University Medical Centre were asked to complete a questionnaire when an adult patient had died. Questionnaires on 1000 consecutive naturally deceased adults were collected. If possible, missing data in the questionnaires were retrieved from the electronic patient record. Results Data from 958 (96%) questionnaires was available for analysis. In 167/958 (17·4%) cases clinicians did not request an autopsy, and in 641/791 (81·0%) cases next-of-kin did not give consent. The most important reason for both clinicians (51·5%) and next-of-kin (51·0%) to not request or consent to an autopsy was an assumed known cause of death. Their second reason was that the deceased had gone through a long illness (9·6% and 29·5%). The third reason for next-of-kin was mutilation of the deceased’s body by the autopsy procedure (16·1%). Autopsy rates were highest among patients aged 30–39 years, Europeans, suddenly and/or unexpectedly deceased patients, and tissue and/or organ donors. The intensive care and emergency units achieved the highest autopsy rates, and surgical wards the lowest. Conclusion The main reason for not requesting or allowing an autopsy is the assumption that the cause of death is known. This is a dangerous premise, because it is a self-fulfilling prophecy. Clinicians should be aware, and communicate with the next of kin, that autopsies not infrequently disclose unexpected findings, which might have changed patient management. Mutilation of the deceased’s body seems a minor consideration of next-of-kin, though how it really affects autopsy rates, should be studied by offering minimally or non-invasive autopsy methods. PMID:27736974

  10. Molecular Pathology of Pulmonary Edema in Forensic Autopsy Cases with Special Regard to Fatal Methamphetamine Intoxication.

    PubMed

    Du, Yu; Jin, Hong-Nian; Zhao, Rui; Zhao, Dong; Xue, Ye; Zhu, Bao-Li; Guan, Da-Wei; Xie, Xiao-Li; Wang, Qi

    2016-11-01

    Pulmonary edema is a common finding in fatal methamphetamine intoxication. However, the underlying mechanism remains poorly understood. This study investigated the molecular pathology of alveolar damage involving pulmonary edema in forensic autopsy cases. Seven candidate reference genes (RPL13A, YWHAZ, GUSB, SDHA, GAPDH, B2M, and ACTB) were evaluated in the lung by the geNorm module in qBase(plus) software. RPL13A, YWHAZ, and GUSB were identified as the most stable reference genes. Using these validated reference genes, intrapulmonary mRNA 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 METH intoxication cases. These findings suggested alveolar damage and compensatory response in fatal METH intoxication cases. Systematic analysis of gene expressions using real-time qPCR is a useful tool in forensic death investigation.

  11. 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.

  12. 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

  13. [An autopsy case of segmental mediolytic arteritis (SMA) accompanied with microscopic polyarteritis nodosa].

    PubMed

    Ito, M R; Ohtani, H; Nakamura, Y; Abe, T; Nose, M

    1995-08-01

    Segmental Mediolytic Arteritis (SMA) is a very rare arterial lesion which is limited in adults to the involvement of the intra-abdominal muscular arteries. The pathology is characterized by segmental disruption of the arterial media which leads segmental mediolysis, with subsequent dissecting aneurysm or rupture. A 73-year-old man was admitted to a hospital because of high fever, general fatigue and weight loss. These symptoms were resistant to antibiotic therapy, and soon after, renal insufficiency developed. Three months after the onset of symptoms, he died suddenly of hemorrhagic shock. Autopsy revealed rupture of the splenic artery and systemic necrotizing arteritis in the small-sized arteries of liver, pancreas and kidneys, as well as in the connective tissues around the adrenal glands. Histopathology of the splenic artery was consistent with SMA, and that of the systemic vascular lesions, with microscopic polyarteritis nodosa. Focal glomerular lesions characteristic of crescentic and/or granulomatous glomerulonephritis were present. A developmental mechanism for SMA is discussed with respect to this case together with a review of previous reports of this disease.

  14. A policy for the retention and extended examination of organs at autopsy.

    PubMed

    Krinsky, Clarissa S; Lathrop, Sarah L; Reichard, Robert Ross

    2010-03-01

    Recent organ retention scandals and law suits have created a focus on the practice of saving postmortem tissues for extended examination or research purposes. The New Mexico Office of the Medical Investigator (OMI) established a policy to notify families about organ retention and the subsequent disposition of the tissue. The OMI examined the success of this policy in regards to the retention of brains for extended examination by analyzing data abstracted from verbal consent forms from 2003 to 2006. During this time, 715 cases were identified as needing an extended examination of the brain. The percentages of brains saved in any given year, as a percent of the total number of autopsies performed that year, were: 2003 6.5%, 2004 10.4%, and 2005 11.8%. The disposition was cremation in 79% of cases, release with the body after a determined period of time in 14%, and cut fresh in 4%. In conclusion, the instigation of a policy on the verbal notification of the next of kin when organs are retained can be successfully implemented.

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

    PubMed

    Christoffersen, S

    2015-05-01

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

  16. Viral Pneumonias in Forensic Autopsies: Evaluation and Classification of Histopathologic Changes With Microbiologic Correlation.

    PubMed

    Daş, Taner; Sargan, Aytül; Yağmur, Gülhan; Yildirim, Muzaffer; Topal, Cumhur Selçuk; Gürler, Ahmet Selçuk; Asliyüksek, Hizir; Arslan, Murat Nihat; Özdemirel, Rifat

    2016-12-01

    Lower respiratory infections are commonly due to viruses and are the third largest cause of death. Respiratory tract viruses have a tendency to target the specific regions in the lung and can harm the host via direct effect of the virus and the host's inflammatory response. In this study, relationships between morphologic changes in the lung and the viral agent type isolated in the lung by the polymerase chain reaction technique were investigated. This study was performed retrospectively at 113 autopsy cases in the Council of Forensic Medicine in Istanbul. Slides from the lung tissues diagnosed as interstitial pneumonia and detected viral agent in polymerase chain reaction were evaluated and reviewed under light microscope by 2 pathologists simultaneously according to predetermined bronchiolar, alveolar, and interstitial findings. Alveolar findings were detected in 108 cases (95.6%), whereas interstitial and bronchiolar findings were detected in 91 (80.5%) and 38 (33.6%) cases, respectively. Intra-alveolar edema was the most common alveolar finding. Some findings such as multinucleated syncytial cells and smudge cells can aid the search for etiologic agent. Interstitial inflammation was the most common histopathologic finding in the lung in viral infections and the most prominent clue to viral infections in the lung histopathologically without discrimination of viral agent type.

  17. 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.

  18. Rapid eye movement sleep behavior disorder and subtypes in autopsy-confirmed dementia with Lewy bodies.

    PubMed

    Dugger, Brittany N; Boeve, Bradley F; Murray, Melissa E; Parisi, Joseph E; Fujishiro, Hiroshige; Dickson, Dennis W; Ferman, Tanis J

    2012-01-01

    The purpose of this study was to determine whether dementia with Lewy bodies with and without probable rapid eye movement sleep behavior disorder differ clinically or pathologically. Patients with dementia with Lewy bodies (DLB) with probable rapid eye movement sleep behavior sleep disorder (n = 71) were compared with those without it (n = 19) on demographics, clinical variables (core features of dementia with Lewy bodies, dementia duration, rate of cognitive/motor changes), and pathologic indices (Lewy body distribution, neuritic plaque score, Braak neurofibrillary tangle stage). Individuals with probable rapid eye movement sleep behavior disorder were predominantly male (82% vs 47%) and had a shorter duration of dementia (mean, 8 vs 10 years), earlier onset of parkinsonism (mean, 2 vs 5 years), and earlier onset of visual hallucinations (mean, 3 vs 6 years). These patients also had a lower Braak neurofibrillary tangle stage (stage IV vs stage VI) and lower neuritic plaque scores (18% vs 85% frequency), but no difference in Lewy body distribution. When probable rapid eye movement sleep behavior disorder developed early (at or before dementia onset), the onset of parkinsonism and hallucinations was earlier and Braak neurofibrillary tangle stage was lower compared with those who developed the sleep disorder after dementia onset. Women with autopsy-confirmed DLB without a history of dream enactment behavior during sleep had a later onset of hallucinations and parkinsonism and a higher Braak NFT stage. Probable rapid eye movement sleep behavior disorder is associated with distinct clinical and pathologic characteristics of dementia with Lewy bodies.

  19. Corticobasal degeneration: an autopsy case clinically diagnosed as progressive supranuclear palsy.

    PubMed

    Shiozawa, M; Fukutani, Y; Sasaki, K; Isaki, K; Hamano, T; Hirayama, M; Imamura, K; Mukai, M; Arai, N; Cairns, N J

    2000-01-01

    We report an autopsy case diagnosed clinically as progressive supranuclear palsy (PSP), but neuropathologically confirmed as corticobasal degeneration (CBD). A 56-year-old Japanese woman slowly developed parkinsonism, dementia, character change, followed by vertical gaze palsy and dystonia. Brain MRI demonstrated diffuse cerebral atrophy with severe shrinkage of the brain stem tegmentum. The SPECT images using 123I-IMP disclosed symmetrical hypoperfusion in the frontal lobes. She died of respiratory failure at the age of 71. Gross inspection of the brain showed diffuse, symmetrical atrophy of the cerebrum and marked atrophy of the Luysian body, globus pallidus, substantia nigra and nuclei of the brain stem tegmentum. Microscopically, neuronal loss and fibrillary gliosis were observed in the Luysian body, globus pallidus, substantia nigra and nuclei of the brain stem tegmentum. The cerebellar dentate nucleus showed mild neuronal loss with some grumose degeneration. Neurofibrillary tangles were found only in the Luysian body, substantia nigra and raphe nuclei, whilst tau-positive inclusions were observed more extensively. Astrocytic plaques and swollen achromatic neurones were found in the postcentral gyrus. There were no tuft-shaped astrocytes in the brain. The clinicopathological similarities and differences between PSP and CBD are discussed.

  20. [An autopsy case of syringomyelia associated with Chiari malformation and basilar impression].

    PubMed

    Isu, T; Iwasaki, Y; Sasaki, H; Abe, H; Tashiro, K; Nakamura, N

    1987-06-01

    The authors report one autopsy case of syringomyelia associated with Chiari malformation and basilar impression. The pathogenesis of syringomyelia in our case is discussed. This 37-year-old man complained of progressive difficulty in swallowing and walking for two years. He had noticed dysarthria for six months before admission. (Examination) Neurological examination showed dysarthria, down beat nystagmus, disturbance of IXth nerve, Xth nerve and XIth nerve, and cerebellar ataxia. Deep tendon reflexes were hyperactive in the upper and lower extremities. Babinski's sign was positive bilaterally. Neuroradiological examination demonstrated basilar impression and Chiari malformation. (Operation) Suboccipital craniectomy and laminectomy of upper cervical vertebra were performed with dural plasty. Postoperatively he acquired some improvement, but soon after he was worse. He died of respiratory disturbance. (Postmortem examination) Though the central canal was obliterated at the C4 level, the syrinx extended from the C5 to Th7 level. From the C5 to C8, the syrinx was present in the areas of central gray matter, extending into the left dorsal horn, where it communicated with subarachnoid space. Furthermore, the abnormal vessels were noticeable around the syrinx. At the Th2 level, they were also shown in central grey matter where no syrinx existed. (Conclusion) The etiology of syringomyelia in our case was not explained by Gardner's hydrodynamic theory. We suggested that intramedullary abnormal vessels played an important part for the formation of the syringomyelia.

  1. Longitudinal brainstem laceration associated with complex basilar skull fractures due to a fall: an autopsy case.

    PubMed

    Zhu, Bao Li; Quan, Li; Ishida, Kaori; Taniguchi, Mari; Oritani, Shigeki; Fujita, Masaki Q; Maeda, Hitoshi

    2002-03-28

    This report describes an autopsy case of a rare longitudinal brainstem laceration associated with complex basilar skull fractures. The victim was a 40-year-old male who died immediately after falling from a roof (9.2m in height) of a factory onto a concrete floor. The postmortem examination revealed an incomplete ring fracture of the base of the skull with longitudinal fractures of the sphenoid (clivus of the dorsum sellae turcicae) and occipital bones, cerebral contusions in the frontal and temporal poles, a longitudinal brainstem laceration at the posterior median sulcus of the pons accompanied with multiple contusional hemorrhages in the brainstem and corpus callosum. Related blunt-force injuries were observed in the parieto-occipital region of the head, shoulder and upper back involving the fractures of the cervical and thoracic vertebrae, and sternum and ribs, indicating a huge impact to the occiput and subsequent impression of the vertebral column into the base of the skull due to violent anteroflexion of the neck, which caused the complex basilar skull fractures, contusions and longitudinal laceration of the brainstem.

  2. 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.

  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.

  4. Pattern of homicidal deaths autopsied at Penang Hospital, Malaysia, 2007-2009: a preliminary study.

    PubMed

    Bhupinder, S; Kumara, T K; Syed, A M

    2010-12-01

    This article describes the homicide pattern in Penang Island, Malaysia over a three-year period (2007-2009). 65 homicide autopsies were performed at the Department of Forensic Medicine, Penang Hospital over the study period. The homicide rates ranged from 0.01 to 0.09/1000 population, the highest being in the Indian ethnic group. The majority (37%) of victims were in the 20-39 years age group. The male: female ratio was 3:1. The majority of deaths were caused by blunt instruments (46%), followed by stab/slash wounds (25%) and asphyxiation (12%). 63% of homicides occurred in areas served by the police stations at Jalan Patani (23.1%), Sg. Nibong (16.9%), Central (12.3%) and Bayan Lepas (10.9%). 56 (86%) victims were brought in dead to the hospital, while 9 (14%) died after admission. Most (39%) incidences occurred in the morning. The methods of homicide were different from Kuala Lumpur, another highly urbanised area of Malaysia.

  5. Cardiac arrhythmia and death of teenager linked to rare genetic disorder diagnosed at autopsy.

    PubMed

    Quick, Jennifer Sue; Dobersen, Michael

    2014-06-01

    A 17-year-old male adolescent sustained cardiac arrest after participating in a wrestling match, where he was thrown down. He had no pulse, and cardiopulmonary resuscitation was immediately initiated along with application of an automatic external defibrillator. Upon arrival of emergency medical services, an electrocardiogram showed the patient to be in ventricular tachycardia, torsades, and ventricular fibrillation. The patient was ultimately transported to the hospital and, with ACLS protocol being performed, was resuscitated to a junctional rhythm with bradycardia and borderline prolonged QT. His hospital stay was characterized by refractory cardiac failure, and 2 days after the incident, a decision was made to remove him from life support. At autopsy, there were no external or internal injuries that could be considered a contributing cause of death. On external examination, observations were made about the decedent's facial features including his nose, eyes, ears, fingers, and toes. A careful review of the decedent's medical history was initiated to reveal birth defects including syndactyly of the third and fourth digit of the upper extremity as well as complete lack of dental enamel. A tentative diagnosis of oculodentodigital dysplasia was made and confirmed by genetic testing of heart muscle taken from the decedent. This case report examines the rare association of oculodentodigital dysplasia with cardiac arrhythmia as well as places emphasis on the features of the disorder that can aid in its diagnosis.

  6. Histological analysis of esophageal muscular layers from 27 autopsy cases with mixed connective tissue disease (MCTD).

    PubMed

    Uzuki, Miwa; Kamataki, Akihisa; Watanabe, Mika; Sasaki, Nobuhito; Miura, Yasuhiro; Sawai, Takashi

    2011-06-15

    Esophageal symptoms in mixed connective tissue disease (MCTD) have been investigated radiologically. We investigated the esophageal lesions in MCTD histopathologically, and analyzed relationships between these lesions and autoantibodies extracted from the serum of MCTD patients. Esophageal tissues from 27 MCTD patients submitted to autopsy were examined. We compared histopathological features of the esophagus in different wall layers from the mucosa, submucosa, and muscular layer to the adventitia, and in the upper, middle, and lower portions of esophagus. The most striking change observed was severe atrophy and occasional loss of smooth muscle cells in the muscular layer, followed by fibrosis. These muscular changes were particularly prominent in the inner layer of the lower esophagus. Immunohistochemically, degenerated muscular tissues of the esophagus were positive for anti-IgG and anti-C3 antibodies, but not for anti-IgM antibodies. IgG fractions extracted from three MCTD patients were immunohistochemically used to examine whether some antibodies in MCTD patients showed reactivity for esophageal components. The IgG fractions isolated from MCTD patients reacted with smooth muscle from non-connective tissue disease cases, suggesting that some serum antibodies may trigger esophageal changes. These findings suggest that esophageal lesions associated with clinical dysphagia in MCTD may be related to autoantibodies.

  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.

  8. [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.

  9. Autopsy study of cerebellar degeneration in siblings with ataxia-telangiectasia-like disorder.

    PubMed

    Oba, Daiju; Hayashi, Masaharu; Minamitani, Motoyuki; Hamano, Shinichiro; Uchisaka, Naoki; Kikuchi, Akira; Kishimoto, Hiroshi; Takagi, Masatoshi; Morio, Tomohiro; Mizutani, Shuki

    2010-04-01

    Ataxia-telangiectasia-like disorder (ATLD) is caused by mutations of the MRE11 gene and is characterized by cerebellar ataxia, increased frequency of chromosomal translocations and hypersensitivity to ionizing radiation. ATLD is a rare genetic disease and the associated pathological changes in the brain are unclear. Here, we report the neuropathological findings in the first cases of genetically confirmed ATLD in a pair of Japanese male siblings. Magnetic resonance imaging studies performed during infancy revealed that both subjects had cerebellar atrophy. They died of pulmonary cancer at 9 and 16 years. The siblings had the same compound heterozygous mutations of the MRE11 gene. Brain autopsy demonstrated mild and severe cerebellar atrophy in the vermis and medial part of the hemispheres, oral to the horizontal fissure, respectively. Nuclear immunoreactivity for MRE11 was absent in neurons of cerebellar cortex, cerebral cortex, basal ganglia and midbrain, whereas being widespread in normal control brains. Immunoreactivity for the DNA oxidative stress marker, 8-hydroxy-2'-deoxyguanosine, was identified in nuclei of granule cells and Bergmann glial cells. The combination of MRE11 deficiency and DNA oxidative injury might have led to selective cerebellar degeneration.

  10. Comparison of hard tissues that are useful for DNA analysis in forensic autopsy.

    PubMed

    Kaneko, Yu; Ohira, Hiroshi; Tsuda, Yukio; Yamada, Yoshihiro

    2015-11-01

    Forensic analysis of DNA from hard tissues can be important when investigating a variety of cases resulting from mass disaster or criminal cases. This study was conducted to evaluate the most suitable tissues, method and sample size for processing of hard tissues prior to DNA isolation. We also evaluated the elapsed time after death in relation to the quantity of DNA extracted. Samples of hard tissues (37 teeth, 42 skull, 42 rib, and 39 nails) from 42 individuals aged between 50 and 83 years were used. The samples were taken from remains following forensic autopsy (from 2 days to 2 years after death). To evaluate the integrity of the nuclear DNA isolated, the percentage of allele calls for short tandem repeat profiles were compared between the hard tissues. DNA typing results indicated that until 1 month after death, any of the four hard tissue samples could be used as an alternative to teeth, allowing analysis of all of the loci. However, in terms of the sampling site, collection method and sample size adjustment, the rib appeared to be the best choice in view of the ease of specimen preparation. Our data suggest that the rib could be an alternative hard tissue sample for DNA analysis of human remains.

  11. An autopsy case of primary pericardial mesothelioma in arc cutter exposed to asbestos through talc pencils.

    PubMed

    Fujiwara, Hiroshi; Kamimori, Takao; Morinaga, Kenji; Takeda, Yoshiki; Kohyama, Norihiko; Miki, Yoshihiro; Inai, Kouki; Yamamoto, Satoru

    2005-04-01

    An autopsy case of a primary pericardial mesothelioma in a 53-year-old arc cutter is reported. He had often had the chance to inhale dust generated by sharpening the slate pencils composed of talc. He was admitted for heart failure due to pericardial tumor, but later died. The tumor was mainly located on the pericardium with a thickness of about 2.5 cm. Small nodular disseminations were observed in the left parietal pleura. Microscopically, tumor cells were epithelial-like and rich in histochemical demonstrable hyaluronic acid. Findings of immunohistochemical markers revealed keratin (+), EMA (+), calretinin (+), and CEA (-), which were characteristics of mesothelioma of epithelial type. The number of asbestos bodies (AB) in the lung parenchyma was increased (2026 AB/gram dry lung tissue). Subsequent transmission electron microscopic examination equipped with an energy dispersive X-ray analyzer revealed that the fibers identified in the lungs were fibrous talc and actinolite. These findings suggested that this patient had been occupationally exposed to asbestos contaminated in the talc pencils, which induced the development of primary pericardial mesothelioma.

  12. 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.

  13. 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.

  14. 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.

  15. Elder abuse and neglect: social problems revealed from 15 autopsy cases.

    PubMed

    Akaza, Kayoko; Bunai, Yasuo; Tsujinaka, Masatake; Nakamura, Isao; Nagai, Atsushi; Tsukata, Yukiyoshi; Ohya, Isao

    2003-03-01

    This study examined the elder abuse cases that occurred in Gifu Prefecture, Japan between 1990 and 2000. We conducted a retrospective study of all the cases in which the victim was 65 years or older and autopsied in the Department of Legal Medicine, Gifu University School of Medicine. Fifteen victims were classified as elder abuse victims: five men and ten women. The victims ranged in age from 66 to 87 years (mean age, 74.5 years). The types of abuse were as follows: physical abuse, 13 cases; emotional abuse, five cases; neglect, four cases; and financial abuse, three cases. In eight cases, the victims were subjected to two or more types of abuse. The cause of death of the victims varied with the type of abuse. In the physical abuse cases, subdural hemorrhage was the most common cause, followed by other violence-related deaths and hypothermia. In the neglect cases, the victims died of either starvation or suffocation after the aspiration of food into the airway. In the domestic abuse cases, one of the victim's sons was the most common perpetrator, and little or no income was considered to be a risk factor for perpetrators. In the neglect cases, dementia and difficulty in performing activities of daily living were considered to be risk factors for victims, in addition to living in social isolation.

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

    PubMed Central

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

    2015-01-01

    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

  17. The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents.

    PubMed

    Moskała, Artur; Woźniak, Krzysztof; Kluza, Piotr; Romaszko, Karol; Lopatin, Oleksij

    2016-01-01

    Since traffic accidents are an important problem in forensic medicine, there is a constant search for new solutions to help with an investigation process in such cases. In recent years there was a rapid development of post-mortem imaging techniques, especially post-mortem computed tomography (PMCT). In our work we concentrated on a potential advantage of PMCT in cases of motorcycle accident fatalities. The results of forensic autopsy were compared with combined results of the autopsy and PMCT to check in which areas use of these two techniques gives statistically important increase in number of findings. The hypothesis was confirmed in case of pneumothorax and fractures of skull, spine, clavicle, scapula, lower leg bones. As for majority of other bone fractures locations and brain injures there were single cases with pathologies visible only in PMCT, but too few to reach expected level of p-value. In case of injuries of solid organs and soft tissues statistical analysis did not confirmed any advantage of unenhanced PMCT use. On the whole it has been shown that PMCT used as an adjunct to forensic autopsy can cause an increase in information about vitally important regions in case of motorcycle accident fatalities.

  18. Pathoanatomic findings and blood alcohol analysis at autopsy (BAC) in forensic diagnoses of undetermined suicide. A cross-cultural study.

    PubMed

    Ferrada-Noli, M; Ormstad, K; Asberg, M

    1996-04-02

    In Sweden, ca. 25% of unnatural deaths ascribed to self-inflicted injury are finally recorded as 'undetermined suicide' (abbreviated UMSA), i.e. the forensic pathologist has not been able to establish whether the fatality was an accident or a suicide. In the present study, a series of UMSA cases was investigated with the aims to study the impact of immigrant status, and alcohol abuse on the occurrence of this forensic diagnosis on the mode of death. The alcohol issue was addressed by focusing on blood alcohol concentrations at autopsy (BAC) and post mortem signs of alcohol-related organ pathology. The results can be summarised as follows: Positive BAC occurred at an equal rate in the UMSA group and in definite suicides, i.e. about 45%. Among non-Swedish UMSA victims positive BAC was more common (50%) than among the Swedish (41%), whereas no difference was found in the definite suicide group. The level of BAC at autopsy was significantly higher in Finnish immigrants than in other ethnic groups. Organic signs of chronic alcohol abuse were found in 13 of 40 cases testing positive for BAC; thus, presence of alcohol at autopsy may reflect incidental intake rather than habitual overconsumption.

  19. Consistency versus completeness in medical decision-making: exemplar of 155 patients autopsied after coronary artery bypass graft surgery.

    PubMed

    Moore, G W; Hutchins, G M

    1983-01-01

    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 with 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 data base of 43,200 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.

  20. 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.

  1. [Clinico-pathological diagnostic agreement among 429 autopsies from the Instituto Nacional de la Nutrición Salvador Zubirán].

    PubMed

    Angeles-Angeles, A; Quintanilla Martínez, L; Muñoz Fernández, L; Espinoza Vázquez, B; Victoría Peralta, P

    1992-01-01

    Comparison of clinical and autopsy findings of the cases studied between 1984 and 1988, were made at the Department of Pathology of the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. The goal was to determine the accuracy of clinical diagnoses. The total number of cases was 429. A decreasing number of autopsies as a function of time was observed. Thus, in 1985, 34.65% of the deaths was autopsied, whereas in 1988, the number dropped to 21.16%, overall mean of 27.31%. In 229 autopsies (53.8%), 353 findings of clinical significance were found; of these, 86 were in the main diagnoses and 267 in the causes of death. There were 171 overdiagnoses with therapeutic implications, 38 in the main diagnoses and 133 in the causes of death. Overdiagnoses and underdiagnoses were most common in infectious diseases, followed by respiratory and digestive diseases, while endocrinologic and rheumatologic diseases had the highest diagnostic concordance. It was also found that the diagnostic accuracy did not improve with time of hospitalization. A brief analyses of the probable causes of the decrease in the number of autopsies is made. It is concluded that, in spite of the great advances in clinical and technological knowledge, the high frequency of disagreements between clinical and anatomical diagnoses, indicate that autopsy continues playing a key role in the quality control of medical practice. This justifies by itself the performance of necropsies.

  2. “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

  3. What caused the 2012 dengue outbreak in Pucallpa, Peru? A socio-ecological autopsy.

    PubMed

    Charette, Margot; Berrang-Ford, Lea; Llanos-Cuentas, Elmer Alejandro; Cárcamo, César; Kulkarni, Manisha

    2017-02-01

    Dengue is highly endemic in Peru, with increases in transmission particularly since vector re-infestation of the country in the 1980s. Pucallpa, the second largest city in the Peruvian Amazon, experienced a large outbreak in 2012 that caused more than 10,000 cases and 13 deaths. To date, there has been limited research on dengue in the Peruvian Amazon outside of Iquitos, and no published review or critical analysis of the 2012 Pucallpa dengue outbreak. This study describes the incidence, surveillance, and control of dengue in Ucayali to understand the factors that contributed to the 2012 Pucallpa outbreak. We employed a socio-ecological autopsy approach to consider distal and proximal contributing factors, drawing on existing literature and interviews with key personnel involved in dengue control, surveillance and treatment in Ucayali. Spatio-temporal analysis showed that relative risk of dengue was higher in the northern districts of Calleria (RR = 2.18), Manantay (RR = 1.49) and Yarinacocha (RR = 1.25) compared to all other districts between 2004 and 2014. The seasonal occurrence of the 2012 outbreak is consistent with typical seasonal patterns for dengue incidence in the region. Our assessment suggests that the outbreak was proximally triggered by the introduction of a new virus serotype (DENV-2 Asian/America) to the region. Increased travel, rapid urbanization, and inadequate water management facilitated the potential for virus spread and transmission, both within Pucallpa and regionally. These triggers occurred within the context of failures in surveillance and control programming, including underfunded and ad hoc vector control. These findings have implications for future prevention and control of dengue in Ucayali as new diseases such as chikungunya and Zika threaten the region.

  4. An autopsy case of cortical superficial siderosis with persistent abnormal behavior.

    PubMed

    Torii, Youta; Iritani, Shuji; Fujishiro, Hiroshige; Sekiguchi, Hirotaka; Habuchi, Chikako; Umeda, Kentaro; Matsunaga, Shinji; Mimuro, Maya; Ozaki, Norio; Yoshida, Mari; Fujita, Kiyoshi

    2016-12-01

    In recent years, MRI has revealed cortical superficial siderosis (cSS), which exhibits hemosiderin deposition in only the cortical surface. However, the associations between the histological findings and clinical symptoms of cSS remain unclear. We herein report an autopsy case of a 75-year-old Japanese man with cSS with persistent abnormal behavior according to cognitive impairment, hallucination and delusion. At 73 years of age, the patient presented with unusual behavior that indicated auditory hallucination and delusion. One year later, he was admitted to the hospital for malignant lymphoma. On admission, cognitive impairment was detected by a screening test. Soon after hospitalization, he presented with active delirium including visual hallucination and delusion. The patient's excited behavior was improved by the administration of a major tranquilizer. However, the abnormal behavior and cognitive impairment persisted. At 75 years of age, he died of heart failure. A neuropathological investigation revealed hemosiderin depositions in the superficial layer of the cortex in the medial and lateral frontal lobe, the lateral temporal lobe, the parietal lobe, and the medial and lateral occipital lobe. Neuritic plaques and diffuse plaques were extensively observed, which corresponded to Braak stage C and CERAD B, although NFTs were observed that corresponded to Braak stage II. Cortical amyloid angiopathy was not observed in any regions. Ischemic change of brain was also mild. Our report suggests that localized deposition of hemosiderin in the cortex might affect the manifestation of cognitive impairments and hallucination. Further clinicopathological studies are needed to clarify the clinical manifestations of patients with cSS.

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

    PubMed Central

    2011-01-01

    Background Plenty of information related to alcoholism can be found in the literature, however, the studies have mostly dealt with the predominance of male alcoholism and data related to addiction in women are desperately scarce and difficult to find. Basic demographic data focusing on the impact of acute alcohol intoxication on the circumstances of death and social behaviour in the alcohol addicted female population are needed especially in the prevention of alcohol related mortality. Methods A retrospective forensic autopsy study of all accidental deaths due to alcohol intoxication over a 12-year period was performed in order to evaluate the locations, circumstances, mechanisms and causes of death. Results A sample of 171 cases of intoxicated women who died due to blood alcohol concentration (BAC) equal to or higher than 2 g/kg was selected. Among them 36.26% (62/171) of women died due to acute alcohol intoxication (AAI). We noted an increase in the number of deaths in women due to AAI from 2 in 1994 up to 5 in 2005 (an elevation of 150% between the years 1994-2005). The age structure of deaths in women due to BAC and AAI followed the Gaussian distribution with a dominant group of women aged 41-50 years (45.16% and 35.09% respectively). The most frequent place of death (98%) among women intoxicated by alcohol was their own home. The study suggests a close connection between AAI and violence against women. Conclusions The increasing number of cases of death of women suffering from AAI has drawn attention to the serious problem of alcoholism in women in the Slovak Republic during the process of integration into "western" lifestyle and culture. PMID:22168833

  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).

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

    PubMed Central

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

    2013-01-01

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

  8. A Bacillus anthracis Genome Sequence from the Sverdlovsk 1979 Autopsy Specimens

    PubMed Central

    Sahl, Jason W.; Pearson, Talima; Okinaka, Richard; Schupp, James M.; Gillece, John D.; Heaton, Hannah; Birdsell, Dawn; Hepp, Crystal; Fofanov, Viacheslav; Noseda, Ramón; Fasanella, Antonio; Hoffmaster, Alex; Wagner, David M.

    2016-01-01

    ABSTRACT Anthrax is a zoonotic disease that occurs naturally in wild and domestic animals but has been used by both state-sponsored programs and terrorists as a biological weapon. A Soviet industrial production facility in Sverdlovsk, USSR, proved deficient in 1979 when a plume of spores was accidentally released and resulted in one of the largest known human anthrax outbreaks. In order to understand this outbreak and others, we generated a Bacillus anthracis population genetic database based upon whole-genome analysis to identify all single-nucleotide polymorphisms (SNPs) across a reference genome. Phylogenetic analysis has defined three major clades (A, B, and C), B and C being relatively rare compared to A. The A clade has numerous subclades, including a major polytomy named the trans-Eurasian (TEA) group. The TEA radiation is a dominant evolutionary feature of B. anthracis, with many contemporary populations having resulted from a large spatial dispersal of spores from a single source. Two autopsy specimens from the Sverdlovsk outbreak were deep sequenced to produce draft B. anthracis genomes. This allowed the phylogenetic placement of the Sverdlovsk strain into a clade with two Asian live vaccine strains, including the Russian Tsiankovskii strain. The genome was examined for evidence of drug resistance manipulation or other genetic engineering, but none was found. The Soviet Sverdlovsk strain genome is consistent with a wild-type strain from Russia that had no evidence of genetic manipulation during its industrial production. This work provides insights into the world’s largest biological weapons program and provides an extensive B. anthracis phylogenetic reference. PMID:27677796

  9. In vivo expression of proinflammatory cytokines in HIV encephalitis: an analysis of 11 autopsy cases.

    PubMed

    Xing, Hui Qin; Hayakawa, Hitoshi; Izumo, Kimiko; Kubota, Ryuji; Gelpi, Ellen; Budka, Herbert; Izumo, Shuji

    2009-08-01

    As the pathogenesis of AIDS dementia complex (ADC), cytokines such as TNF-alpha and IL-1beta have been thought to have toxic effects on CNS cells and induce neuronal cell death. However, many of the discussions have been based on the studies done by in vitro experiments. There are only a few reports which demonstrate proinflammatory cytokines directly in vivo in HIV encephalitis (HIVE) brains, and roles of these cytokines with relation to HIV-1 infection are not yet clarified. In the present study, we examined 11 autopsy cases of HIVE using immunohistochemistry, and explored which cell types expressed these cytokines and whether expression of cytokines was related to viral infection. IL-1beta was detected in the frontal white matter of all 11 cases where microglial nodules were observed to varying degrees, whereas TNF-alpha was detected in seven cases. IL-1beta- or TNF-alpha-positive cells were almost restricted to CD68-positive macrophages/microglia and mild expression of these cytokines by astrocytes was observed in two cases with severe HIVE. IL-1beta was detected in some HIVp24-positive multinucleated giant cells. However, we could not detect TNF-alpha expression in the HIVp24-positive cells, which indicates that IL-1beta is induced by HIV-1 infection. In conclusion, a macrophage/microglia lineage is the main cell type to release cytokines in HIVE, and IL-1beta expression by HIV-1-infected cells may be one of the important factors for induction of HIVE. In addition, many non-infected macrophages/microglia as well as some astrocytes express IL-1beta and TNF-alpha, which might contribute to pathogenesis of ADC.

  10. 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

  11. 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.

  12. The nipple-areola complex epidermis: a prospective systematic study in adult autopsies.

    PubMed

    Val-Bernal, José Fernando; Diego, Cristina; Rodriguez-Villar, Diana; Garijo, María Francisca

    2010-12-01

    The prevalence of different types of clear cells and of the mite Demodex in the nipple-areola complex of adult autopsies of both sexes not suffering from breast cancer was studied in a total of 140 nipples. The epidermis of the nipple-areola complex shows squamous cells and 3 types of clear cells: Toker cells, pagetoid dyskeratosis cells, and signet ring-like cells. Toker cells were identified by standard light microscopy in 13 of 140 nipples (9.3%). Reactivity of these cells for CK7 was observed in 35 nipples (25%). They are derived from the lactiferous duct epithelium. Pagetoid dyskeratosis cells were identified in 56 of 140 nipples (40%). In 12 nipples, these cells were conspicuous (8.6%). It is suggested that the proliferation of these cells is induced by friction. Signet ring-like cells were identified in 71 nipples (50.7%). In 2 nipples, these cells were conspicuous (1.4%). They are a consequence of artefact related to formalin fixation. The prevalence of all these clear cells has no relationship with gender. Routine histopathological examination is usually enough to distinguish the characteristic features of the clear cells involving the nipple epidermis and permits differentiation of other entities with epidermal pale cells. Demodex mites were observed in 58 nipple-areola complexes (41.4%). They were more common in male nipple-areola complexes (P < 0.05). The prevalence of these mites was seen to remain steady along the years since the third decade. Demodex mites are common parasites of human nipple and are apparently of no pathologic significance.

  13. 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.

  14. Pulmonary pathology in surfactant-treated preterm infants with respiratory distress syndrome: an autopsy study.

    PubMed

    Toti, P; Buonocore, G; Rinaldi, G; Catella, A M; Bracci, R

    1996-01-01

    The present study examines the histological features of the lungs of neonates who died of respiratory distress syndrome or related complications after surfactant therapy. Our aim was to determine whether these lungs showed any unusual histological findings. Complete autopsies were performed 6-12 h after death in 10 surfactant-treated preterm infants and in 30 infants who died before surfactant therapy was available. Representative paraffin sections of all pulmonary lobes, stained with haematoxylin and eosin, were examined microscopically. A few selected slides were also stained with periodic acid-Schiff, Vierhoff-van Gieson, and Mallory trichrome. Hyaline membrane disease and bronchopulmonary dysplasia were present in each group, although there was an increased incidence of intra-alveolar haemorrhage in surfactant-treated babies (in 8 of 10 surfactant-treated as compared with 7 of 30 untreated babies). Amongst those treated with surfactant, we observed the persistence of acute alveolar damage with unresolved hyaline membrane disease in 5 infants who died at the ages of 5, 6, 10, 12, and 13 days, respectively, and histological evidence of pneumocyte type 2 hyperplasia and dysplasia in 2 infants who died at 22 and 41 days of age, respectively. These observations reveal that surfactant-treated infants who fail to respond to therapy have continuing alveolar injury and an increased incidence of intra-alveolar haemorrhage. Since oxygen radicals can induce pneumocyte damage and necrosis and since free radicals provoke alveolar haemorrhage in animal models, we propose that the lesions we observed may stem from a lack, in some preterm babies, of specific mechanisms that detoxify oxygen radicals.

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

    PubMed Central

    Takei, Kako; Ikeda, Shinobu; Arai, Tomio; Tanaka, Noriko; Muramatsu, Masaaki; Sawabe, Motoji

    2008-01-01

    Background Lymphotoxin-alpha (LTA) is a pro-inflammatory cytokine with anti-tumor activity. The objective of this study was to determine whether LTA polymorphisms influence the presence of cancer. Methods LTA polymorphisms C804A (rs1041981, T60N) and T495C (rs2229094, C13R) were determined in 1,536 consecutive autopsy cases and were registered in the Japanese single-nucleotide polymorphisms (SNPs) for geriatric research (JG-SNP) Internet database. Tumors were systematically reviewed, pathologically confirmed, and assessed in relation to LTA genotype. Results The study population consisted of 827 males and 709 females, with a mean age of 80 years. Altogether, we studied 606 subjects without cancer and 930 subjects with cancer of the stomach (n = 183), lung (n = 164), colon or rectum (n = 143), or other sites. The presence of cancer was higher in males than in females. The C804A and T495C polymorphisms were associated with cancer in males (CA + AA: CC, adjusted OR = 0.72, 95% CI = 0.53 – 0.99; TC + CC: TT, adjusted OR = 1.45, 95% CI = 1.04 – 2.02; respectively) but not in females. In males, the C804A polymorphism was associated with lung cancer (CA + AA: CC, adjusted OR = 0.60, 95% CI = 0.37 – 0.97), whereas the T495C polymorphism was associated with gastric cancer (TC + CC: TT, adjusted OR = 1.68, 95% CI = 1.06 – 2.65). Conclusion We found some evidence of an association between LTA polymorphisms and cancer risk in elderly Japanese men. Further studies in larger populations should examine this hypothesis. PMID:18700950

  16. Recognition memory span in autopsy-confirmed Dementia with Lewy Bodies and Alzheimer's Disease.

    PubMed

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

    2015-08-01

    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.

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

    PubMed

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

    2012-05-15

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

  18. 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

  19. Prevalence of prostate cancer across the globe: what can autopsy studies teach us about this peculiar disease?

    PubMed

    Zlotta, Alexandre R; Kuk, Cynthia

    2014-06-01

    Prostate cancer (PCa) represents a major public health burden in the western world. It is a peculiar disease as more men die with it than from it. Also interestingly, PCa was virtually unknown for centuries until the 20th century. Randomized trials on PCa screening have outlined the risks of over-diagnosis and over-treatment of latent cancers. Significant geographical differences in PCa incidence and mortality exist, being supposedly low among Asian men compared to Caucasians. In some areas like Korea and Japan, changes have been observed that cannot be explained easily by changing diagnostic procedures and increases in mortality may be due to lifestyles and dietary changes. We have recently studied and compared the prevalence of PCa in Caucasian (CAU) from Moscow, Russia and Asian (ASI) men from Tokyo, Japan. We chose a specific Cau population in Russia with little sun exposure and high fat diet but without widespread PSA screening. Autopsy data in western countries (North America and Europe) would have been heavily contaminated due to opportunistic PSA screening. Screening in Asi men in Japan is uncommon. Prostates were removed en-block with the seminal vesicles within 24 hours of death and analyzed in toto (perpendicular sections at 4 mm intervals) by an experienced uro-pathologist in Toronto. PCa was found on autopsy in a similar proportion of Russian Caucasian and Japanese men. Over 50% of cancers are Gleason ≥7 in Japanese and nearly 25% in Russian Caucasian men raising questions about 1) previous assumptions related to Asian PCa and 2) the notion of significant vs. insignificant cancers. Autopsy studies are key to improve our understanding of this very curious cancer.

  20. 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

  1. An autopsy study of coronary atherosclerosis and its relation to anthropometric measurements/indices of overweight and obesity in men.

    PubMed

    Rastogi, Prateek; Pinto, Denver S; Pai, Mukta R; Kanchan, Tanuj

    2012-01-01

    Atherosclerosis accounts for a large proportion of cardiovascular system associated morbidity and mortality. The present autopsy based study is aimed to study the correlation between coronary atherosclerosis and anthropometric measurements/indices of overweight and obesity such as; Waist Circumference (WC), Hip Circumference (HC), Body Mass Index (BMI), and Waist Hip Ratio (WHR) in men from southern India. The present research also analyses the correlation between anthropometric measurements/indices of overweight and obesity in men with number of coronaries affected with atherosclerosis in individuals. The study included 50 autopsies conducted in the Government District Wenlock Hospital, Mangalore during March and September 2008. The heart was dissected following standard autopsy protocol and a 5 cm section of the right coronary artery (RCA) in the atrio-ventricular groove from its origin, a 5 cm segment of the left anterior descending artery (LADA) distal to the origin of the circumflex artery, but including the region of origin of the circumflex branch and left coronary artery (LCA) from its origin till the circumflex branch were excised, dissected out, fixed in 10% formalin, marked for identification and sent for histopathological analysis. The study shows a positive correlation of WC and WHR with atherosclerotic changes in the RCA. The number of arteries affected with atherosclerosis is found to be well correlated with WC, BMI and WHR. The study confirms an association between anthropometric measurements/indices of obesity, grade of atherosclerosis in the RCA and the number of arteries affected with atherosclerosis. Anthropometric measurements/indices of obesity can be an effective means to identify high risk cases of atherosclerosis at an early stage that can be effective in reducing the associated cardiac morbidity and mortality.

  2. Pulmonary alveolar microlithiasis with cor pulmonale: an autopsy case demonstrating a marked decrease in pulmonary vascular beds.

    PubMed

    Terada, Tadashi

    2009-11-01

    Pulmonary alveolar microlithiasis (PAM) is a very rare autosomal recessive disorder in which microliths are formed in the alveolar space. PAM is infrequently complicated by pulmonary hypertension, the cause of which is unclear. The author in this paper found that the pulmonary hypertension was caused by a marked decrease in pulmonary vascular beds. Here, an autopsy case of PAM with a marked cor pulmonale is reported. A 14-year-old woman was found to have an abnormal pulmonary shadow, but the cause was unclear. At 24 years, she was diagnosed with a diffuse pulmonary abnormal shadow. At 42 years, she was diagnosed with PAM by imaging techniques. Her condition gradually worsened and she had to be treated with oxygen. She died of respiratory failure at 54 years. An autopsy revealed severe PAM and marked cor pulmonale. The heart weighed 360 g and right ventricular thickness was 10 mm (normal, 2-3 mm). Microscopically, the alveolar space was diffusely filled with microliths, and heart failure cells were recognized. Bone formations were scattered. The alveolar walls showed fibrous thickening, and pulmonary arteries showed atherosclerosis. The right ventricle showed marked cardiac hypertrophy. Chronic severe liver congestion was noted. A morphometric analysis using CD34-stained specimens showed a marked decrease (one tenth) in pulmonary capillary beds (capillary number: 8.6 +/- 3.1 per image), compared with normal lungs obtained from two other autopsies (85.3 +/- 9.4 and 96.2 +/- 10,3). It was concluded that the cor pulmonale and pulmonary hypertension in the present case were caused by the marked decrease of the pulmonary arterial vascular beds. More research is required regarding the etiology and treatment of PAM.

  3. Hepatocellular carcinoma. A study of 50 autopsy cases with detection of hepatitis B surface antigen in fixed tissues.

    PubMed

    Perez-Barrios, A; Colina-Ruizdelgado, F; Gallego, I; Martinez-Tello, F J

    1983-03-01

    Fifty patients who died of hepatocellular carcinoma (HCC) were autopsied at the Ciudad Sanitaria "1 degree de Octubre" and the Hospital de la Cruz Roja (Madrid) from 1974 to 1980. Formalin fixed paraffin-embedded autopsy tissue of liver and tumor from the 50 HCC and liver tissue from 50 liver cirrhosis (LC) and from 50 autopsy of non cirrhotic control cases were examined for the presence of cytoplasmic hepatitis B surface antigen (HBsAg). The study was carried out using orcein staining, immunoperoxidase technique (IP) and indirect immunofluorescence (IF). In livers with HCC the HBsAg was detected in the cytoplasm of the hepatocytes in 10 cases (20%) with the orcein staining and in 11 (22%) with the IP and IF techniques. In one case (2%) HBsAg was found in the cytoplasm of tumor cells with the three methods--In four cases (8%) of LC and 2 (4%) control cases cytoplasmic positive cells were found. In 41 patients with HCC HBsAg was studied in the serum by radio-immunoassay (RIA) (13 cases) and immunodiffussion (28 cases). 5 patients (12,1%) were positive and 36 (72%) were negative. In the 5 serum positive HBsAg HCC the staining methods for cytoplasmic HBsAg were positive (100%). In 36 serum negative HBsAg HCC the staining method were positive in 2 cases. The results let us to conclude that HBV is a probable important etiologic factor of HCC in our milieu. 54% of the patients with HCC had a previous history of alcohol abuse; however, histologic features compatible with an alcoholic etiology were found in only 5 cases. Nevertheless we consider that the described histopathologic findings do not exclude excess alcohol consumption as a possible etiologic factor for HCC in our series.

  4. 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.

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

    PubMed

    Høyer, Christian Bjerre; Ulhøi, Benedicte Parm; Charles, Annie Vesterby

    2013-12-01

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

  6. [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.

  7. An autopsy case of subacute cor pulmonale due to pulmonary tumor cell emboli in a patient with gastric cancer.

    PubMed

    Iwakami, Shin-ichiro; Sato, Teruhiko; Takagi, Haruhi; Fujii, Mitsuhiro; Iwakami, Naoko; Yoshimi, Kaku; Koyama, Ryo; Ichikawa, Masako; Yoshioka, Masakata; Takahashi, Kazuhisa

    2009-01-01

    A 53-year-old woman was admitted to our hospital due to a severe respiratory condition and malnutrition. Radiological and electrophysiological findings suggested the existence of inexplicable cor pulmonale. Although we commenced to determine the causes of her severe condition, she suddenly died 3 days after admission. Postmortem autopsy revealed tumor cell microemboli in the small pulmonary arteries due to gastric cancer. Such a case of cor pulmonale as the first clinical manifestation is exceptionally rare. Occult malignancy should be considered as a differential diagnosis when one encounters a patient with subacutely aggravated respiratory condition and inexplicable cor pulmonale.

  8. Residues of organochlorine pesticides, polychlorinated biphenyls, and mercury and autopsy data for bald eagles, 1969 and 1970

    USGS Publications Warehouse

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

    1972-01-01

    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.

  9. [Forensic autopsy cases of battered children in Japan (1990-1999)].

    PubMed

    2002-09-01

    The investigation committee of Japanese Society of Legal Medicine has investigated 459 forensic autopsy cases of battered children from 1990-1999. The age range was 0-4 years of 381 cases (83%). Of them, the age less than 1 year was high as 161 cases (35.1%). The cause of death including head injury was 161 cases (35.1%), suffocation caused by nasal blockages 37 cases (8.1%), strangulation 32 cases (7.0%), and drowning 30 cases (6.5%) was revealed. In case of assailant, own mother was 226 cases (49.2%), own father was 73 cases (15.9%) and stepfather 46 cases (10.0%) were reported. The intention of cruelty was that the body was positively assaulted (84.3%) and duration was less than 2 months in 136 cases (67%). The nature of cruelty was that beating by other hands (16.8%) in 77 cases and pushed away and threw (1.7%) in 8 cases and those complex (7.8%) in 36 cases. The motive of cruelty when he assailant was own mother (209 cases) was as fellow: 1. Mentally abnormal (15.3%), 2. Irresponsibility (14.4%), 3. Victim cries (5.7%). When the assailant was own father (63%), the motive of cruelty was as 1. Victim cries (12.7%), 2. Lack of love (7.9%), 3. Reassisted attitude (6.3%). Reported death in high temperature was in 29 cases (6.3%) and strangulation was in 27 cases (5.9%). The homicide was 13% and neither care nor protection (neglect) was 2.7%. The physical conditions of battered children were emaciated and stunted growth in 128 cases (31.2%). The past history of medical consultation to the medical hospital was 32 cases (17.8%). Among the injuries, external findings consist of abrasions and bruises were 147 cases (32%) and internal findings were 70 cases (16.7%) mainly numerous gastro-intestinal tract injuries than liver and lungs. In addition, lung edema (16.8%) in 68 cases, thymus atrophy (12.6%) in 51 cases and amalgamation (4.5%) in 18 cases were reported. The injury around the anus and genitalia were 13 cases (3.2%). The bone fracture was not observed in 368

  10. 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

  11. Immunohistochemical diagnosis of myocarditis on (infantile) autopsy material: Does it improve the diagnosis?

    PubMed

    Grasmeyer, Sarah; Madea, Burkhard

    2015-06-01

    as valid. At least in infants, the diagnosis of myocarditis from autopsy tissues still requires application of the Dallas criteria. Immunohistochemical methods cannot replace the conventional diagnosis of myocarditis.

  12. Levels of aggressiveness are higher among alcohol-related suicides: results from a psychological autopsy study.

    PubMed

    Chachamovich, Eduardo; Ding, Yang; Turecki, Gustavo

    2012-09-01

    Suicide is one of the major causes of deaths worldwide. Several studies have showed that alcohol use disorders (AUD) are associated with suicide ideation, suicide attempts, and suicide completion. The majority of the theoretical conceptualization and the bulk of evidence on suicidal behavior and AUD are based on investigations of nonfatal cases because data on nonfatal suicidal behaviors are more readily available. This study aims to explore demographic, clinical, and behavioral dimensions in a large sample of alcohol-related suicides compared to an age-gender matched sample of non-AUD suicides to identify specific factors associated with AUD suicides. We conducted a psychological autopsy study with 158 pairs of AUD and non-AUD suicides. Findings showed that AUD suicides have lower educational level, more biological children and were more likely to be heavy smokers (OR=3.32). Cases were more likely to have family history of alcohol (OR=1.73) and drug abuse (OR=3.61). Subjects had similar prevalences of depressive disorders, anxiety disorders or psychotic disorders. AUD suicides were more likely to meet criteria for current cocaine abuse/dependence (OR=6.64). With respect to personality disorders, AUD suicides presented higher prevalence of Antisocial Personality Disorder (OR=4.68), and were less likely to meet criteria for Avoidant (OR=0.26) and Obsessive-Compulsive Personality Disorders (OR=0.35). Impulsivity scores were higher in AUD suicides (p=0.18), as well as aggression scores (p<0.001). Results form the conditional logistic regression models showed that cocaine abuse/dependence (OR=4.20) and Antisocial Personality Disorder (OR=6.24) were associated with AUD suicide. After controlling for impulsive-aggressive behaviors, levels of aggression were the only psychopathological feature statistically different between AUD and non-AUD suicides (OR=1.28). In conclusion, higher levels of aggressive behaviors are a specific characteristic of AUD suicides. Apart from

  13. 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

  14. Comparison of changing autopsy trends in the Bronx population with acquired immunodeficiency syndrome.

    PubMed

    Concepcion, L; Markowitz, G S; Borczuk, A C; Factor, S M

    1996-10-01

    The opportunistic infections, malignancies, and causes of death related to acquired immunodeficiency syndrome (AIDS) are changing, perhaps as a result of improved treatment, prophylaxis, and education. With its high percentage of persons who acquired the human immunodeficiency virus from intravenous drug (IVD) use, the population of patients with AIDS in the Bronx is potentially unique. All of the 257 consecutive adult human immunodeficiency virus and/or AIDS cases from two Bronx teaching hospitals from 1982 through 1995 were collected. The reports were reviewed for patient demographics, opportunistic infections, malignancies, and causes of death. One hundred thirteen cases from 1982 through 1988 were compared with 144 cases from 1989 through 1995, separated by the institution of antiretroviral therapy and Pneumocystis carinii (PCP) prophylaxis in the latter period. Male homosexuality as a risk factor significantly decreased from 24.8% of the cases in our study from the 1982/88 period to 12.5% during the 1989/95 period (P = 0.014), but IVD use cases showed no change. Cases of AIDS in heterosexual patients increased from 23.9 to 36.1% (P = 0.041) but did not achieve statistical significance unless the unknown risk category (a population shown to be infected predominantly through heterosexual transmission) was included. The prevalence of PCP at autopsy as an opportunistic infection decreased from 37.2 to 25% (P = 0.04), and its prevalence as a cause of death decreased from 31.9 to 13.9% (P = 0.007). This decrease was seen in the homosexual and heterosexual populations but not in the population of IVD users. The homosexual population, as opposed to the population of IVD users, may have taken greater advantage of PCP treatment and prevention. As a result, bronchopneumonia, not PCP, is now the leading cause of death among the patients with AIDS in this study. These findings have important implications for therapy and prophylaxis to control the spread of AIDS and its

  15. Aluminum phosphide fatalities at mild exertion in asymptomatic children: a clue to understand the variations of the autopsy findings.

    PubMed

    Abder-Rahman, Hasan A

    2009-08-01

    Fatalities resulted from aluminium phosphide (ALP) intoxication in completely healthy children with no preceded clinical sings or symptoms were presented. Data regarding circumstances, autopsy reports, histopathological examination, toxicological investigation, and police enquiries were also collected and evaluated. The affected children were females, and 6-16 years old. They were completely healthy and died suddenly in relation to some physical activities such as running, walking, and bathing, without any prior complain. The viscera showed intense congestion with moderate to severe pulmonary edema. The cause of the sudden termination of life in the reported cases is mostly cardiac ones. Physical exertion may precipitate death due to increased cardiac stress, increased oxygen demand, and by aggravating metabolic acidosis. The absence of clinical symptoms before death may be due to the low level ALP, or due to the occurrence of death in the early stages after exposure to poison. Death due to ALP could result in cases of mild, moderate, or severe ALP intoxication. This may explain partly the differences encountered in clinical, autopsy, and histopathology findings of ALP intoxication. Fatalities are not the mere consequences of the dose of the poison, but factors such as physical activity and low oxygen level may be quite important.

  16. First autopsy analysis of a neovascularized arterial network induced by indirect bypass surgery for moyamoya disease: case report.

    PubMed

    Mukawa, Maki; Nariai, Tadashi; Inaji, Motoki; Tamada, Natsumi; Maehara, Taketoshi; Matsushima, Yoshiharu; Ohno, Kikuo; Negi, Mariko; Kobayashi, Daisuke

    2016-05-01

    The object of this study was to analyze the pathology of collateral vessels newly induced by indirect bypass surgery for moyamoya disease (MMD). An autopsy analysis was conducted on a 39-year-old woman with MMD who had died of a brainstem infarction. The patient had undergone bilateral indirect bypass surgeries 22 years earlier. Sufficient revascularization via bilateral external carotid arterial systems was confirmed by cerebral angiography before her death. Macroscopic observation of the operative areas revealed countless meandering vessels on the internal surface of the dura mater connected with small vessels on the brain surface and in the subpial brain tissue. Notably, microscopic analysis of these vessels revealed the characteristic 3-layer structure of an arterial wall. This autopsy analysis was the first to confirm that indirect bypass surgery had induced the formation of a new arterial network (arteriogenesis) and that this network had been maintained for more than 20 years to compensate for the chronic cerebral ischemia caused by the MMD.

  17. Examination of the clinicopathologic continuum of Alzheimer disease in the autopsy cohort of the National Alzheimer Coordinating Center.

    PubMed

    Serrano-Pozo, Alberto; Qian, Jing; Monsell, Sarah E; Frosch, Matthew P; Betensky, Rebecca A; Hyman, Bradley T

    2013-12-01

    To test the hypothesis that Alzheimer disease (AD) is a clinical and pathologic continuum between normal aging and end-stage dementia, we selected a convenience sample of subjects from the National Alzheimer Coordinating Center 2005 to 2012 autopsy cohort (n = 2,083) with the last clinical evaluation within 2 years before autopsy and no other primary neuropathologic diagnosis. Demographic and neuropathologic characteristics were correlated with the Clinical Dementia Rating-Sum of Boxes in the 835 subjects meeting these criteria. Both neuritic plaques and neurofibrillary tangles independently predicted Clinical Dementia Rating-Sum of Boxes. Severe small-vessel disease, severe amyloid angiopathy, and hippocampal sclerosis were also independently associated with the degree of cognitive impairment. By contrast, education was a strong independent protective factor against cognitive deficits. The cause of mild to moderate dementia remained uncertain in 14% of the patients. Inverse probability weighting suggests the generalizability of these results to nonautopsied cohorts. These data indicate that plaques and tangles independently contribute to cognitive impairment, that concurrent vascular disease strongly correlates with cognitive dysfunction even in a sample selected to represent the AD pathologic continuum, and that education further modifies clinical expression. Thus, multiple concomitant etiologies of brain damage and premorbid characteristics contribute to the uncertainty of AD clinicopathologic correlations based only on tangles and plaques.

  18. The Spectrum of Clinical and Pathological Manifestations of AIDS in a Consecutive Series of 236 Autopsied Cases in Mumbai, India

    PubMed Central

    Lanjewar, Dhaneshwar Namdeorao

    2011-01-01

    The HIV epidemic in the Asian subcontinent has a significant impact on India. The AIDS associated pathology has not been well evaluated in a representative study hence very little is known about the spectrum of HIV/AIDS associated diseases in Indian subcontinent. To determine the important postmortem findings in HIV infected individuals in Mumbai, autopsy study was carried out. The patient population included patients with AIDS who died at the tertiary care hospital over a 20 year period from 1988 to 2007. A total of 236 (182; 77% males and 54; 23%) females) patients with AIDS were autopsied. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%) and 223/236 (94%) patients died of HIV-related diseases. Tuberculosis was the prime cause of death in 149 (63%) patients, followed by bacterial pneumonia 33 (14%), cryptococcosis 18 (8%), toxoplasmosis of brain 15 (6%), pneumocystis jiroveci (PCJ) 1 (0.5%) and Non-Hodgkin's lymphoma 7 (3%) cases. The major underlying pathologies are either preventable or treatable conditions. There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries. Reducing mortality in patients with AIDS from infections must be highest public health policy in India. PMID:21660276

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

    PubMed

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

    2014-12-01

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

  20. [Systemic Buschke's scleredema with cardiomyopathy, monoclonal IgG kappa gammopathy and amyloidosis. Case report with autopsy].

    PubMed

    Paz, R A; Badra, R E; Martí, H M; Maxit, M J

    1998-01-01

    A 73 year old retired truck driver and blacksmith was studied in June 1996 for thoracic pain and was diagnosed as acute pericarditis which responded well to steroid treatment. In January 1997, he noted swelling of the abdominal skin, genitalia and limbs, sparing the feet. He was euthyroid, did not have evidence of diabetes or a Raynaud's phenomenon. His proteinogram showed an IgG-Kappa monoclonal paraprotein M component, 1.31 g/oo. TSH and tetraiodotironine were normal; ESR 16 mm in the first hour. As he did not respond to treatment he was referred to our hospital in March 1997. On physical examination the most relevant findings were a non-pitting edema of the abdomen and lower limbs, sparing the feet. An echocardiogram was consistent with an infiltrative cardiomyopathy. Soon after his hospitalization his condition worsened suddenly with severe bradicardia (28/minute) due to a junctional rhythm and righ bundle branch block. He suffered a cardiac arrest and died. The autopsy findings favoured the diagnosis of systemic scleredema adultorum of Buschke. Amyloid deposits were also found although not abundant, with a similar distribution except in the skin. In this article the clinical and autopsy findings are presented in a patient showing coexistence of systemic Buschke's scleredema with an infiltrative cardiomyopathy, IgG Kappa gammopathy and amyloidosis.

  1. Virtopsy - the concept of a centralized database in forensic medicine for analysis and comparison of radiological and autopsy data.

    PubMed

    Aghayev, Emin; Staub, Lukas; Dirnhofer, Richard; Ambrose, Tony; Jackowski, Christian; Yen, Kathrin; Bolliger, Stephan; Christe, Andreas; Roeder, Christoph; Aebi, Max; Thali, Michael J

    2008-04-01

    Recent developments in clinical radiology have resulted in additional developments in the field of forensic radiology. After implementation of cross-sectional radiology and optical surface documentation in forensic medicine, difficulties in the validation and analysis of the acquired data was experienced. To address this problem and for the comparison of autopsy and radiological data a centralized database with internet technology for forensic cases was created. The main goals of the database are (1) creation of a digital and standardized documentation tool for forensic-radiological and pathological findings; (2) establishing a basis for validation of forensic cross-sectional radiology as a non-invasive examination method in forensic medicine that means comparing and evaluating the radiological and autopsy data and analyzing the accuracy of such data; and (3) providing a conduit for continuing research and education in forensic medicine. Considering the infrequent availability of CT or MRI for forensic institutions and the heterogeneous nature of case material in forensic medicine an evaluation of benefits and limitations of cross-sectional imaging concerning certain forensic features by a single institution may be of limited value. A centralized database permitting international forensic and cross disciplinary collaborations may provide important support for forensic-radiological casework and research.

  2. Forensic pathological evaluation of postmortem pulmonary CT high-density areas in serial autopsy cases of sudden cardiac death.

    PubMed

    Michiue, Tomomi; Ishikawa, Takaki; Oritani, Shigeki; Kamikodai, Yasunobu; Tsuda, Kohei; Okazaki, Shuji; Maeda, Hitoshi

    2013-10-10

    Previous studies suggested substantial postmortem interference with pulmonary CT findings. The present study evaluated postmortem CT (PM-CT) morphology of the lung, compared with histology, in autopsy cases of sudden cardiac death without recovery from cardiac arrest (SCD, n=22) with regard to the posture at the time of death and postmortem interference from a forensic pathological viewpoint. In witnessed cases (n=5), a case of SCD in a prone position had anterior consolidation with weak hypostatic opacification in the posterior about 18 h later. Among unwitnessed deaths (n=17), 8 cases of death lying prone, sitting facedown and lying laterally had possible gravity-dependent opacity about 15-38 h postmortem. Hypostatic opacification with 'niveau' formation was not evident in more than half of the cases (n=15). Histological findings for ground glass opacification and consolidation on PM-CT varied by case, involving intraalveolar edema and hemorrhages, accompanied by marked congestion; however, possible postmortem hypostatic opacification mostly represented intraalveolar edema. CT morphology of acute pulmonary congestion in SCD may often remain without serious postmortem interference in cases without clinical intervention involving massive fluid infusion, suggesting plain PM-CT findings of the lung to be useful for investigating the death process when combined with histology; however, the possible influence of the hydration status of the lungs at the time of death should be assessed by evaluation of CT and autopsy findings.

  3. 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.

  4. 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.

  5. Direct estimation of cause-specific mortality fractions from verbal autopsies: multisite validation study using clinical diagnostic gold standards

    PubMed Central

    2011-01-01

    Background Verbal autopsy (VA) is used to estimate the causes of death in areas with incomplete vital registration systems. The King and Lu method (KL) for direct estimation of cause-specific mortality fractions (CSMFs) from VA studies is an analysis technique that estimates CSMFs in a population without predicting individual-level cause of death as an intermediate step. In previous studies, KL has shown promise as an alternative to physician-certified verbal autopsy (PCVA). However, it has previously been impossible to validate KL with a large dataset of VAs for which the underlying cause of death is known to meet rigorous clinical diagnostic criteria. Methods We applied the KL method to adult, child, and neonatal VA datasets from the Population Health Metrics Research Consortium gold standard verbal autopsy validation study, a multisite sample of 12,542 VAs where gold standard cause of death was established using strict clinical diagnostic criteria. To emulate real-world populations with varying CSMFs, we evaluated the KL estimations for 500 different test datasets of varying cause distribution. We assessed the quality of these estimates in terms of CSMF accuracy as well as linear regression and compared this with the results of PCVA. Results KL performance is similar to PCVA in terms of CSMF accuracy, attaining values of 0.669, 0.698, and 0.795 for adult, child, and neonatal age groups, respectively, when health care experience (HCE) items were included. We found that the length of the cause list has a dramatic effect on KL estimation quality, with CSMF accuracy decreasing substantially as the length of the cause list increases. We found that KL is not reliant on HCE the way PCVA is, and without HCE, KL outperforms PCVA for all age groups. Conclusions Like all computer methods for VA analysis, KL is faster and cheaper than PCVA. Since it is a direct estimation technique, though, it does not produce individual-level predictions. KL estimates are of similar

  6. Oxygen as a cause of blindness in premature infants: "autopsy" of a decade of errors in clinical epidemiologic research.

    PubMed

    Jacobson, R M; Feinstein, A R

    1992-11-01

    Several intellectual "autopsies" have recently reviewed errors in clinical epidemiologic studies of causation, such as the original claim that amyl nitrite "poppers" caused AIDS. The current autopsy was done to determine why it took more than a decade--1942 to 1954--to end an iatrogenic epidemic in which high-dose oxygen therapy led to retrolental fibroplasia (RLF) in premature infants, blinding about 10,000 of them. The autopsy revealed a museum of diverse intellectual pathology. When first noted, RLF was regarded as neither a new disease nor a postnatal effect. In early investigations, the ophthalmologists did not establish explicit criteria for diagnosis and confused RLF with malformations previously seen in full-term infants. Because the patients were not referred until months after birth, the ophthalmologists assumed that the lesion, which resembled an embryologic structure, must have occurred prenatally. Other events suggesting a prenatal cause for RLF were its strong statistical associations with fetal anomalies, multiple gestations, and maternal infections. Although these events were also associated with prematurity, it was ignored when the RLF cases were compared with controls who were mainly full-term infants. The postnatal timing of RLF was eventually recognized when investigators did cohort studies in premature infants and found that RLF could develop in eyes that were normal at birth. As the search for a cause turned to events occurring after birth, statistical associations were produced for agents such as light, vitamins, iron, vitamin E deficiency, and hypoadrenalism. Each study had its own methodologic flaws: controls were missing for light; co-maneuvers were ignored for vitamins and iron; objective diagnosis was not used for vitamin E deficiency; and the research on hypoadrenalism contained biases in susceptibility and detection as well as problems of a competing outcome event. When the role of oxygen administration was first considered, the

  7. The Subclonal Architecture of Metastatic Breast Cancer: Results from a Prospective Community-Based Rapid Autopsy Program “CASCADE”

    PubMed Central

    Flensburg, Christoffer; Alsop, Kathryn; Mansour, Mariam; Francis, Prudence A.; Thorne, Heather A.; Silva, Maria Joao; Kanu, Nnennaya; Dietzen, Michelle; Bowtell, David D.; Speed, Terence P.; Swanton, Charles; Loi, Sherene

    2016-01-01

    Background Understanding the cancer genome is seen as a key step in improving outcomes for cancer patients. Genomic assays are emerging as a possible avenue to personalised medicine in breast cancer. However, evolution of the cancer genome during the natural history of breast cancer is largely unknown, as is the profile of disease at death. We sought to study in detail these aspects of advanced breast cancers that have resulted in lethal disease. Methods and Findings Three patients with oestrogen-receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer and one patient with triple negative breast cancer underwent rapid autopsy as part of an institutional prospective community-based rapid autopsy program (CASCADE). Cases represented a range of management problems in breast cancer, including late relapse after early stage disease, de novo metastatic disease, discordant disease response, and disease refractory to treatment. Between 5 and 12 metastatic sites were collected at autopsy together with available primary tumours and longitudinal metastatic biopsies taken during life. Samples underwent paired tumour-normal whole exome sequencing and single nucleotide polymorphism (SNP) arrays. Subclonal architectures were inferred by jointly analysing all samples from each patient. Mutations were validated using high depth amplicon sequencing. Between cases, there were significant differences in mutational burden, driver mutations, mutational processes, and copy number variation. Within each case, we found dramatic heterogeneity in subclonal structure from primary to metastatic disease and between metastatic sites, such that no single lesion captured the breadth of disease. Metastatic cross-seeding was found in each case, and treatment drove subclonal diversification. Subclones displayed parallel evolution of treatment resistance in some cases and apparent augmentation of key oncogenic drivers as an alternative resistance mechanism. We

  8. Organ retention and communication of research use following medico-legal autopsy: a pilot survey of university forensic medicine departments in Japan.

    PubMed

    Tsujimura-Ito, Takako; Inoue, Yusuke; Yoshida, Ken-ichi

    2014-09-01

    This study investigated the circumstances and problems that departments of forensic medicine encounter with bereaved families regarding samples obtained from medico-legal autopsies. A questionnaire was posted to all 76 departments of forensic medicine performing medico-legal autopsies in Japan, and responses were received from 48 (63.2%). Of the respondents, 12.8% had approached and communicated with bereaved families about collecting samples from the deceased person during an autopsy and the storage of the samples. In addition, 23.4% of these had informed families that samples might be used in research. Eighteen departments had received enquiries and requests from families about the samples, with most requests concerning their return. The response to such requests varied according to the department. Few departments interacted with the bereaved families regarding the procedure for obtaining autopsy samples, and their methods for handling family concerns differed depending on the person within the department authorised to contact the family. Moreover, the procedures for engaging in such communication have long been unclear, and no legal or ethical consensus or agreement with the general public has been established. It is important for researchers to further discuss the correct way for forensic medicine departments to communicate with bereaved families.

  9. Segmental arterial mediolysis of varying phases affecting both the intra-abdominal and intracranial vertebral arteries: an autopsy case report.

    PubMed

    Ro, Ayako; Kageyama, Norimasa; Takatsu, Akihiro; Fukunaga, Tatsushige

    2010-01-01

    We report an autopsy case of segmental arterial mediolysis (SAM) of various phases occurring in both the intracranial vertebral artery (IVA) and intra-abdominal arteries. The patient was a 70-year-old male found dead in his house. The cause of death was massive intra-abdominal hemorrhage owing to a ruptured right gastroepiploic artery. Histopathological examination revealed that there was a broad arterial dissection as long as 20 cm in the right gastroepiploic artery associated with SAM in the injurious phase. In addition, SAM in the reparative phase was observed as organized arterial dissections in the left gastric artery. Furthermore, SAM in the reparative phase was detected as an arterial dissection in the right IVA undergoing an organizing process. These three lesions were considered to have developed at different times. SAM occurring in both the intra-abdominal and intracranial vertebral arteries is extremely rare. This coincidence may provide a clue to the relationship between SAM and spontaneous IVA dissection.

  10. 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

  11. An autopsy case of hemiconvulsion-hemiplegia-epilepsy syndrome manifesting as cerebral hemiatrophy in an elderly man.

    PubMed

    Iwase, Tamaki; Yoshida, Mari; Mizuno, Tomoyuki; Sato, Shinya; Nokura, Kazuya

    2015-12-01

    We report an autopsy case of hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome in a 79-year-old man. HHE syndrome usually occurs in children younger than 4 years of age. Although most HHE syndrome patients live into adult life, only a few cases of the syndrome have been reported in the elderly. In our case, cerebral hemiatrophy, left mesial temporal sclerosis and crossed cerebellar atrophy were observed. Because this is the oldest case ever reported, we further investigated age-related neuropathological changes and found an interhemispheric difference in amyloid-β-related neuropathologic changes. There were almost no senile plaques or amyloid-laden vessels in the left hemisphere. As far as we know, this is the first report of age-related neuropathology in a brain manifesting HHE syndrome.

  12. FORENSIC Autopsy of People Having Committed Suicide in 2002 and in 2012: Comparison of Epidemiological and Sociological Data.

    PubMed

    Franchi, Angélique; Bagur, Jacques; Lemoine, Patrick; Maucort-Boulch, Delphine; Malicier, Daniel; Maujean, Géraldine

    2016-01-01

    This work compares epidemiological and sociological data on persons having committed suicide in 2002 and in 2012 through a retrospective study of every suicide case having led to an autopsy at the Institute for Forensic Medicine of Lyon in 2002 and in 2012. The study included sociodemographic data, medical data, and toxicological data. A total of 486 cases were included (242 cases in 2002 and 244 cases in 2012). People committing suicide were on average older in 2012 than in 2002 with a larger proportion of over 55. There was also an increase in the proportion of psychiatric antecedents (p < 0.001). Whatever the date of death by suicide, the most affected age range is the 45-54. The results highlight the necessity of bolstering the prevention plans, in particular for people over 45.

  13. Fatal thoracic aortic aneurysm in a patient with childhood-onset vasculo-Behçet's disease: an autopsy report.

    PubMed

    Yazawa, S; Ishihara, A; Kawasaki, S

    2001-11-01

    A 33-year-old man died following sudden unexpected rupture of a saccular thoracic aortic aneurysm. The patient had been treated as suspicious Behçet's disease (BD) for 9 years, however, the medication was discontinued at the age of 24. Autopsy disclosed multiple aneurysms at the descending thoracic and abdominal aorta. Histopathologically, infiltration of inflammatory cells and destruction with loss of elastic and muscle fibers of the aortic medial wall were seen. Taking the clinical course into account, all the postmortem findings were compatible with those of vasculo-BD. It is important that medical follow-up should be implemented even for childhood-onset patients who do not satisfy criteria of BD.

  14. Clinical and Autopsy Diagnoses of Visceral Affections of Patients Who Died Because of Complicated Burns with Multi-organ Failure

    PubMed Central

    Taran, A.; Baciu, N.; Rafulea, V.; German, A.

    2005-01-01

    Summary The anatomicopathological investigations carried out in a total number of 186 cadavers during the last decade were reviewed. In these retrospective studies of necropsy protocols related to different affections of visceral organ systems that evolved asymptomatically, 30.1% involved the neurological system, 36.0% the uropoiesis system, 34.4% the gastrointestinal system, 52.0% the hepatobiliary system, and 39.7% the cardiovascular system, with a prevalence in the pulmonary system of 64.2%. A comparative analysis of the incidence of affections detected in various visceral organs (on the basis of necropsy data in the 186 burn patients) and the incidence of their clinical manifestations showed that in 35% of patients with extensive and deep burns all of these conditions developed asymptomatically and were diagnosed only through autopsy. PMID:21991003

  15. Determination of Both Fetus' and Mother's Blood Type from an Autopsy Case Immersed in Formalin for Over 50 Years.

    PubMed

    Uno, Akari Takaya; Morita, Satomu; Furukawa, Satoshi; Nishi, Katsuji; Hitosugi, Masahito

    2016-07-01

    A female fetus which had been immersed in formalin for more than 50 years was found in Japan. Because no liquid blood could be obtained, we tried to use immunohistochemistry (IHC) methods to tissue samples obtained at autopsy to identify both the fetal and mother's blood type. We detected B antigens on endothelial cells in paraffin sections of the fetal organs. Furthermore, we observed both anti-A- and anti-B-positive red blood cells in the intervillous space, which is indicative of the mother's blood type. To our knowledge, this is the first case report on determining the blood type of both the fetus and the mother from tissue immersed in formalin for such a long time. The results suggest that IHC is valuable for the determination of ABO blood type in circumstances of long postmortem duration and unfavorable storage conditions.

  16. [Mononeuritis multiplex due to thrombotic ischemia of primary antiphospholipid antibody syndrome without vasculitis: an autopsy case report].

    PubMed

    Takahashi, Masatoshi; Katada, Fumiaki; Sato, Susumu; Shibayama, Hidehiro; Fukutake, Toshio; Murayama, Shigeo

    2015-01-01

    The patient was a 78-year-old man. Three years before admission, he developed transient peripheral neuropathy and purpura, and at admission, he presented with livedo reticularis of both his lower extremities and with mononeuritis multiplex. Vasculitis was not observed, and antiphospholipid antibodies were detected. The nerve and skin biopsies revealed no inflammation; axonal degeneration accompanied by thrombi was found in his arterioles and venules. Based on these findings, he was diagnosed with ischemic peripheral neuropathy due to primary antiphospholipid syndrome. Administration of anticoagulant therapy resulted in an improvement in symptoms; however, two months later, a relapse occurred, and the patient contracted an infection while undergoing immunosuppressive therapy. The infection became fulminant, and the patient succumbed to multiple organ failure. The autopsy revealed a systemic arterial and venous embolism; however, no vasculitis was observed. Antiphospholipid syndrome, which is responsive to antithrombotic treatment, should be considered as a differential diagnosis of mononeuritis multiplex.

  17. [Influence of inhaling carbon monoxide-containing gas in fire fatalities--an investigation of forensic autopsy cases].

    PubMed

    Zhu, Bao-Li; Ishikawa, Takaki; Michiue, Tomomi; Tanaka, Sayaka; Li, Dong-Ri; Zhao, Dong; Oritani, Shigeki; Ogawa, Masafumi; Maeda, Hitoshi

    2007-01-01

    To investigate the influence of inhaling carbon monoxide (CO)-containing gases in fires, forensic autopsy cases of fire victims (n=193) were examined in comparison with control cases involving other causes of fatal CO intoxication (n=6 :COHb, 69.5-83.0%). Fire victims with blood carboxyhemoglobin (COHb) levels over 60% (n=76) showed a larger arterio-venous difference in blood COHb level compared with other fire victims and other fatal CO intoxication. However, biochemical findings for myocardial, cerebral damage or respiratory distress were milder in most cases, independent of blood cyanide levels, being similar to those in fatality due to inhalation of blast furnace gas with an extremely high concentration of CO (ca. 40%). These observations suggest that an acutely fatal factor in fires involves inhalation of gases containing high amounts of CO, which may induce peracute circulatory collapse before causing marked myocardial and cerebral damage or respiratory distress.

  18. What does psychological autopsy study tell us about charcoal burning suicide--a new and contagious method in Asia?

    PubMed

    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

    2009-12-01

    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 diagnoses with the exception of schizophrenic spectrum disorder which was less frequently associated with charcoal burning suicides. Score on "neuroticism" in the NEO-five Factor Inventory (NEO-FFI) was significantly higher in victims of charcoal burning suicide. There was also a trend toward higher score on "conscientiousness" in the NEO-FFI among charcoal burners than victims of other suicide.

  19. 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.

  20. [Relationship between alcohol consumption and external causes of death based on the forensic autopsy cases in Yamaguchi].

    PubMed

    Hakucho, Ayako; Kawamura, Haruka; Liu, Jinyao; Liu, Xu; Takase, Izumi; Fujimiya, Tatsuya

    2014-06-01

    We analyzed forensic autopsy cases to assess the relationship between alcohol consumption and external causes of death. We divided 605 autopsy cases which had been performed from 2000 to 2011 at our department into Alcohol group (n = 172, 28.4%) and Non-alcohol group (n = 433, 71.6%) according to whether alcohol could be detected in the deceased's blood. The individuals' sex and age, season when the death occurred, cause of death, type of death and circumstances of death were analyzed. Alcohol group had a significantly higher ratio of males and younger ages (both p < 0.05). There was no significant between-group difference regarding the seasons when the deaths occurred. Alcohol group had significantly greater rates of spinal injuries, abdominal injuries, traffic accidents, and accidental drowning. "Bicycling" was revealed as a related factor of the traffic accidents only in Alcohol group. In contrast, "accident on the expressway," "riding a motorcycle," and "a passenger in a vehicle" were related factors only in Non-alcohol group. We concluded that the factors of male gender and middle-to-senior age are responsible for the increased risk of external causes of death after alcohol consumption, and that alcohol consumption is one of the risk factors for accidental death. In Japan, drunk-driving-related accidents have shown a downward trend whereas bicycling-related accidents have shown an upward trend, and similar results were obtained in the present study. The low awareness of drinking-induced pitfalls may be responsible for drinking-related bicycle accidents.

  1. 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

  2. [Implications of nicotine detected in autopsy cases of newborn babies and infants from the perspective of social medicine].

    PubMed

    Nishimura, Hiroyuki; Furumiya, Junichi; Nakanishi, Akinori; Hashimoto, Yoshiaki

    2011-10-01

    Smoking by pregnant and parturient women is generally suspected to increase nicotine levels in fetal and infant blood. Supportive data of nicotine levels in infants is, however, inadequate. We investigated blood and muscle nicotine and cotinine levels in 14 autopsy cases of newborn babies and infants using gas chromatography. Among the 14 cases investigated, nicotine or cotinine was detected in six cases (42.9%). In each of these six cases, the mother was a smoker. Route of exposure to nicotine originating from smoking was transplacental in three cases, via breast milk in one case and secondhand smoke in two cases. Nicotine and cotinine levels in blood from the two cases with placental exposure were 10.6-84.4 ng/ml and 20.3-183 ng/ml, and levels in muscle from one case were 43.9 ng/g and 308 ng/g, respectively. Nicotine and cotinine levels in blood from exposure via breast milk were 19.1 ng/ml and 87.1 ng/ml, and from secondhand smoke were 0 ng/ml and 14.6-20.1 ng/ml. Mean concentrations of blood nicotine and cotinine in 68 autopsy cases of adult habitual smokers were 30.0 ng/ml and 247 ng/ml. Our data for nicotine and cotinine levels in infant blood seem to indicate that some infants who are born and develop under exposure to smoking by family members, particularly the mother, may show high nicotine levels in blood and experience possible health risks.

  3. Association of non-synonymous variants in WIPF3 and LIPA genes with abdominal aortic aneurysm: an autopsy study

    PubMed Central

    Maeda, Yuko; Sato, Noriko; Naka-Mieno, Makiko; Mori, Seijiro; Arai, Tomio; Tanaka, Masashi; Muramatsu, Masaaki; Sawabe, Motoji

    2016-01-01

    Background Abdominal aortic aneurysm (AAA) is a multifactorial disease with strong genetic components. Various genetic loci have been associated with clinical AAA, but few studies have investigated pathological AAA, an intermediate phenotype of the disease. Methods We examined 2263 consecutive autopsies of older Japanese subjects from a study on geriatric diseases in Japanese individuals (The JG-SNP study). The presence of AAA was determined with a pathological diagnosis during autopsy. Single nucleotide variants (SNVs) associated with AAA were determined with an Illumina HumanExome Beadchip array. Logistic regression analyses were performed to determine genetic associations. Age, gender, and other risk factors of AAA were analyzed as covariates. Results 118 subjects with AAA and 2145 subjects without AAA were analyzed in a case-control setting. No variants reached significance after applying the Bonferroni correction (P < 2.05×10−6). The strongest associations were found with rs3750092 (p.E321G, OR: 0.36, 95% CI: 0.24–0.56, P = 6.09 × 10−6), a variant in the WAS/WASL interacting protein family 3 (WIPF3), and with rs1051338 (p.T16P, OR: 2.50, 95% CI: 1.70–3.66, P = 2.79 × 10−6) and rs2246942 (intronic, OR: 2.32, 95% CI: 1.58–3.41, P = 1.61 × 10−5), variants in the lysosomal acid lipase A (LIPA). LIPA is essential for macrophage cholesterol metabolism. Immunohistological analyses of WIPF3 protein in AAA samples from three subjects revealed that WIPF3 was expressed in macrophages of atheromatous plaques. Conclusions This study suggests that WIPF3 and LIPA, both of which are expressed in the macrophages are involved in pathological AAA. These results should be regarded as hypothesis-generating; thus, replication study is warranted. PMID:28321238

  4. 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

  5. Automatic ICD-10 multi-class classification of cause of death from plaintext autopsy reports through expert-driven feature selection

    PubMed Central

    Mujtaba, Ghulam; Shuib, Liyana; Raj, Ram Gopal; Rajandram, Retnagowri; Shaikh, Khairunisa; Al-Garadi, Mohammed Ali

    2017-01-01

    Objectives Widespread implementation of electronic databases has improved the accessibility of plaintext clinical information for supplementary use. Numerous machine learning techniques, such as supervised machine learning approaches or ontology-based approaches, have been employed to obtain useful information from plaintext clinical data. This study proposes an automatic multi-class classification system to predict accident-related causes of death from plaintext autopsy reports through expert-driven feature selection with supervised automatic text classification decision models. Methods Accident-related autopsy reports were obtained from one of the largest hospital in Kuala Lumpur. These reports belong to nine different accident-related causes of death. Master feature vector was prepared by extracting features from the collected autopsy reports by using unigram with lexical categorization. This master feature vector was used to detect cause of death [according to internal classification of disease version 10 (ICD-10) classification system] through five automated feature selection schemes, proposed expert-driven approach, five subset sizes of features, and five machine learning classifiers. Model performance was evaluated using precisionM, recallM, F-measureM, accuracy, and area under ROC curve. Four baselines were used to compare the results with the proposed system. Results Random forest and J48 decision models parameterized using expert-driven feature selection yielded the highest evaluation measure approaching (85% to 90%) for most metrics by using a feature subset size of 30. The proposed system also showed approximately 14% to 16% improvement in the overall accuracy compared with the existing techniques and four baselines. Conclusion The proposed system is feasible and practical to use for automatic classification of ICD-10-related cause of death from autopsy reports. The proposed system assists pathologists to accurately and rapidly determine underlying

  6. 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

  7. 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

  8. 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

  9. Distribution of cerebello-olivary degeneration in idiopathic late cortical cerebellar atrophy: clinicopathological study of four autopsy cases.

    PubMed

    Ota, Satoru; Tsuchiya, Kuniaki; Anno, Midori; Niizato, Kazuhiro; Akiyama, Haruhiko

    2008-02-01

    Late cortical cerebellar atrophy (LCCA) is a neurodegenerative disease which presents with slowly progressive cerebellar ataxia as a prominent symptom and is characterized neuropathologically by a limited main lesion to the cerebellar cortex and inferior olivary nucleus. To elucidate the features of lesions in the cerebellar cortex and inferior olivary nucleus, four autopsy cases suffering from idiopathic LCCA without other cortical cerebellar atrophies, such as alcoholic cerebellar degeneration, phenytoin intoxication, or hereditary cerebellar atrophy including spinocerebellar ataxia type 6, were examined. All affected patients had identical distinct features of cerebellar cortical lesions. In all four cases, the most obvious pathological finding throughout the cerebellum was loss of Purkinje cells, but the rarefaction of granular cell layers was observed only where loss of Purkinje cells was very severe, and thinning of the molecular layer was seen only where the rarefaction of granular cell layers was moderate to severe. Two patients presented with vermis dominant cerebellar cortical lesions, but the other two patients showed hemispheric dominant pathological changes. Neuronal loss of the inferior olivary nucleus was observed in the three autopsy cases. Two of the three cases had a prominent lesion in the dorsal part of the inferior olive and the cerebellar cortical lesion disclosed the vermis dominance, but the other patient, showing prominent neuronal loss in the ventral olivary nucleus, had a cerebellar hemisphere dominant lesion. The patient without neuronal loss in the inferior olivary nucleus had suffered from a shorter period of disease than the others and the rarefaction of granular cell layers and narrowing of the molecular layer of the cerebellar cortex were mild. Therefore, it is obvious that there are two types of cerebellar cortex lesions in idiopathic LCCA; one is vermis dominant and the other is cerebellar hemispheric dominant. The lesion of the

  10. Epidemiology of visceral mycoses in autopsy cases in Japan: comparison of the data from 1989, 1993, 1997, 2001, 2005 and 2007 in Annual of Pathological Autopsy Cases in Japan.

    PubMed

    Kume, Hikaru; Yamazaki, Toshikazu; Togano, Tomiteru; Abe, Michiko; Tanuma, Hiroyuki; Kawana, Seiji; Okudaira, Masahiko

    2011-01-01

    The data on visceral mycoses reported in the " Annual of Pathological Autopsy Cases in Japan " were analyzed epidemiologically every four years from 1989 to 2005, and in 2007. The frequency rates of visceral mycoses dropped sharply between 1989 (4.5%) and 1994 (3.2%), but by 2001 had risen again and have remained (4.4-4.6%) generally stable since then. The predominant causative agents were Candida and Aspergillus. Although the rate of candidosis showed a gradual decrease, the rate of aspergillosis showed an increase by degrees. Furthermore, the rate of aspergillosis exceeded that of candidosis in 1994, and the difference in the rates between the two conditions apparently further increased until 2001. After 2005, however no changes in this difference were observed. For complicated infections, the incidence of coinfection with Aspergillus and Candida showed a decreasing, and that with Aspergillus and Zygomycetes showed an increasing tendency. Severe infections with Zygomycetes showed a clear increase from 57.4% in 1989 to 88.9% in 2007. Comparing underlying diseases with mycoses in 1989 and 2007, leukemia (including myelodysplastic syndrome) decreased from 26.1% to 18.8% and bacterial infections (including interstitial pneumonia) increased from 11.1% to 22.1%. By age, the highest frequency rate of mycoses was observed in the range of 60-79 years, and the frequency rate of exogenous fungal infections such as aspergillosis, cryptococcosis, zygomycosis and trichosporonosis showed an increasing trend in the less than one-year old group.

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

    PubMed

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

    2012-03-01

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

  12. An autopsy case of otogenic intracranial abscess and meningitis with Bezold's abscess: evaluation of inflammatory bone destruction by postmortem cone-beam CT.

    PubMed

    Kanawaku, Yoshimasa; Yanase, Takeshi; Hayashi, Kino; Harada, Kazuki; Kanetake, Jun; Fukunaga, Tatsushige

    2013-11-01

    The deceased was an unidentified young male found unconscious on a walkway. On autopsy, outer and inner fistulae of the left temporal bone, subcutaneous abscess in the left side of the neck and head, and an intracranial abscess were noted. A portion of the left temporal bone was removed and scanned by cone-beam computed tomography (CT) (normally used for dentistry applications) to evaluate the lesion. The cone-beam CT image revealed roughening of the bone wall and hypolucency of the mastoid air cells, consistent with an inflammatory bone lesion. According to autopsy and imaging findings, the cause of death was diagnosed as intracranial abscess with Bezold's abscess secondary to left mastoiditis as a complication of otitis media. Although determining the histopathology of bone specimens is time-consuming and costly work, we believe that use of cone-beam CT for hard tissue specimens can be useful in forensic practice.

  13. Association between cerebrospinal fluid dopamine concentrations and catechol-O-methyltransferase gene polymorphisms in forensic autopsy cases of methamphetamine abusers.

    PubMed

    Matsusue, Aya; Ishikawa, Takaki; Michiue, Tomomi; Waters, Brian; Hara, Kenji; Kashiwagi, Masayuki; Takayama, Mio; Ikematsu, Natsuki; Kubo, Shin-Ichi

    2017-01-01

    Methamphetamine (MA) is an illicit psychostimulant that stimulates the release of catecholamines from sympathetic nerve terminals and is widely abused worldwide. Since catechol-O-methyltransferase (COMT) metabolizes catecholamines and mediates adrenergic, noradrenergic, and dopaminergic signaling responses, we investigated the effects of the COMT polymorphisms rs4633 and rs4680 on cerebrospinal fluid (CSF) catecholamine concentrations in autopsies of subjects who died of drug intoxication. 28 MA abusers and 22 fatal psychotropic drug intoxication cases were evaluated. No correlations were identified between rs4633 or rs4680 polymorphisms and CSF concentrations of adrenaline (Adr), noradrenaline (Nad), or dopamine (DA) in fatal psychotropic cases. However, among MA abusers, DA concentrations in the CSF were significantly higher in those with the T allele (CT and TT) of rs4633 than in CC genotype carriers (p=0.004). Moreover, among MA abusers, DA concentrations were significantly higher in those with the A allele (GA and AA) of rs4680 than in GG genotype carriers (p=0.017). In subsequent haplotype analyses of MA abusers, a strong correlation was identified between two COMT haplotypes and CSF DA concentrations (p=0.002). However, the CSF concentrations of Adr and Nad were not associated with COMT genotypes or haplotypes. The present results indicate that rs4633 and rs4680 polymorphisms influence CSF DA concentrations and MA toxicity in MA abusers.

  14. 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.

  15. 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.

  16. Toxicological analysis of 17 autopsy cases of hydrogen sulfide poisoning resulting from the inhalation of intentionally generated hydrogen sulfide gas.

    PubMed

    Maebashi, Kyoko; Iwadate, Kimiharu; Sakai, Kentaro; Takatsu, Akihiro; Fukui, Kenji; Aoyagi, Miwako; Ochiai, Eriko; Nagai, Tomonori

    2011-04-15

    Although many cases of fatal hydrogen sulfide poisoning have been reported, in most of these cases, it resulted from the accidental inhalation of hydrogen sulfide gas. In recent years, we experienced 17 autopsy cases of fatal hydrogen sulfide poisoning due to the inhalation of intentionally generated hydrogen sulfide gas. In this study, the concentrations of sulfide and thiosulfate in blood, urine, cerebrospinal fluid and pleural effusion were examined using GC/MS. The sulfide concentrations were blood: 0.11-31.84, urine: 0.01-1.28, cerebrospinal fluid: 0.02-1.59 and pleural effusion: 2.00-8.59 (μg/ml), while the thiosulfate concentrations were blood: 0-0.648, urine: 0-2.669, cerebrospinal fluid: 0.004-0.314 and pleural effusion: 0.019-0.140 (μmol/ml). In previous reports, the blood concentration of thiosulfate was said to be higher than that of sulfide in hydrogen sulfide poisoning cases, although the latter was higher than the former in 8 of the 14 cases examined in this study. These results are believed to be strongly influenced by the atmospheric concentration of hydrogen sulfide the victims were exposed to and the time interval between exposure and death.

  17. A case of 37 year long Behçet disease resembling Takayasu arteritis: An autopsy report.

    PubMed

    Sato, Naoko; Irie, Koji; Kouzuma, Ryoji; Inoue, Katsumi; Nakayama, Toshiyuki

    2016-01-18

    A 19-year-old woman with a history of recurrent aphthous stomatitis and genital ulceration was diagnosed with Behçet disease. She was treated with steroids and immunosuppressive agents for more than 30 years, but multiple complications manifested including ileocecal ulcer, aortic valve regurgitation, renal failure, ischemic enterocolitis, and arteriosclerotic obliterans until her death at the age of 56 from pneumonia. An autopsy examination demonstrated an entirely calcified aorta and major aortic branches. The ascending aorta was dilatated 55 mm in diameter and branches were all stenosed. Microscopically, the aortic arch and its branches showed collagenous fibrosis of the outer media and adventitia, whereas coronary and abdominal aortic branches showed conventional atherosclerosis. Although the ante-mortem diagnosis was angio-Behçet disease, its pathophysiology along with her clinical history, morphology of the lead pipe-like aorta, predominant destruction of the outer arteries, and a human leukocyte antigen (HLA) haplotype of B39 were all suggestive of Takayasu arteritis. Thus, this case implies that HLA-B39 may be associated with the pathogenesis of arteritis like Takayasu arteritis, even if the primary disease is Behçet disease.

  18. An autopsy case of neuronal intermediate filament inclusion disease with regard to immunophenotypic and topographical analysis of the neuronal inclusions.

    PubMed

    Inoue, Kimiko; Fujimura, Harutoshi; Ueda, Kayo; Matsumura, Tsuyoshi; Itoh, Kyoko; Sakoda, Saburo

    2015-12-01

    We report an autopsy case of neuronal intermediate filament inclusion disease (NIFID), in which pyramidal motor dysfunction preceded cognitive disturbance for 3 years from the onset. A 41-year-old Japanese man presented progressive spastic tetraparesis followed by cognitive impairment. His neurological symptoms gradually deteriorated and he died of pneumonia 16 years from the onset. His brain showed severe generalized atrophy with enlargement of ventricles. The microscopic examination revealed severe neuronal loss with gliosis and sponginess predominantly in the fronto-temporal cortices, caudate and putamen. Many hyaline conglomerate inclusions (HC) without immunoreactivity for 'fused in sarcoma' protein (FUS) and some granular and small round FUS-immunoreactive (FUS-ir) neuronal cytoplasmic inclusions (NCI) were observed in the remaining neurons. Some neurons with HC had small basophilic inclusions which showed positive FUS-ir, attached to HC in the cytoplasm. Otherwise, FUS-ir large compact inclusions (so-called Pick-like) were also observed but were scarce. In the cerebral cortex and the neostriatum, frequency of the inclusions was well correlated with neuronal loss. In the brainstem, neuronal loss was mild and FUS-ir inclusions dominated. In the subthalamic nucleus and red nucleus, there was no HC but there were many FUS-ir inclusions without neuronal loss. The above findings suggest that cytoplasmic mislocalization and aggregation of FUS appear at the early stage of the disease, and the FUS aggregate process may not be a direct precedent structure of HC.

  19. 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

  20. 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.

  1. Longitudinally Extensive Transverse Myelitis with Intramedullary Metastasis of Small-Cell Lung Carcinoma: An Autopsy Case Report

    PubMed Central

    Tanaka, Ryota; Tsutsumi, Satoshi; Oji, Yutaka; Saeki, Harumi; Yasumoto, Yukimasa; Ito, Masanori; Hattori, Nobutaka; Urabe, Takao

    2013-01-01

    Background. Longitudinally extensive transverse myelitis (LETM) is characterized by spinal cord inflammation extending vertically through three or more vertebral segments. The widespread use of MRI revealed LETM more frequency than ever. We report the case of a patient with pathologically confirmed small-cell lung carcinoma metastasis into the spinal cord presenting as LETM. Case Presentation. A 74-year-old man developed rapidly progressive sensorimotor disturbance and vesicorectal dysfunction. T2-weighted magnetic resonance imaging of the spine revealed LETM at the level of from T3 to conus medullaris; gadolinium enhancement showed concurrent tumor in the thoracic spinal cord from T10 to T11. Systemic survey identified a nodular mass in the lung that was verified as small-cell carcinoma. Following initial failed treatment by high-dose steroid, the patient underwent an emergent microsurgical tumor resection. Histological examination was identical with the lung carcinoma. The patient died of tumor progression at the 47th day after admission. At autopsy, only changes of edema were found in the gray matter of the cord, while tumor cells were not noted in it. Conclusion. Metastasis may rarely present symptoms of LETM. Prompt identification of underlying etiology by contrast examination and systemic survey is crucial for the patient assumed as LETM. PMID:24455343

  2. Causes of death in diarrhoeal diseases after rehydration therapy: an autopsy study of 140 patients in Bangladesh

    PubMed Central

    Butler, T.; Islam, M.; Azad, A. K.; Islam, M. R.; Speelman, P.

    1987-01-01

    The cause of death (besides dehydration) for 140 diarrhoeal patients who died in hospital following rehydration was determined by autopsy examination. Children under 5 years comprised 74% of the patients. Diarrhoeal pathogens were identified as Shigella spp. in 27%, enterotoxigenic Escherichia coli in 17%, Entamoeba histolytica in 16%, Campylobacter jejuni in 12%, Salmonella spp. in 4%, Vibrio cholerae in 4%, and Giardia lambliain 4% of cases. The most frequent underlying causes of death were colitis in 44% and pneumonia in 38%. The most frequent immediate causes of death were septicaemia in 27%, hypoglycaemia in 9%, and hypokalaemia in 9%; multiple causes of death were present in 89% of cases. Kwashiorkor or marasmus was present in 59% and fatty degeneration of the liver was detected in 61% of cases. It is concluded that, in susceptible children, diarrhoeal pathogens produce destructive inflammation in the intestine and cause death or contribute to it by provoking disease in other tissues, especially septicaemia and fatty liver, or by combining these effects with antecedent or concomitant conditions, especially pneumonia and malnutrition. PMID:3499247

  3. Molecular pathology of brain matrix metalloproteases, claudin5, and aquaporins in forensic autopsy cases with special regard to methamphetamine intoxication.

    PubMed

    Wang, Qi; Ishikawa, Takaki; Michiue, Tomomi; Zhu, Bao-Li; Guan, Da-Wei; Maeda, Hitoshi

    2014-05-01

    Methamphetamine (METH) is a highly addictive drug of abuse and toxic to the brain. Recent studies indicated that besides direct damage to dopamine and 5-HT terminals, neurotoxicity of METH may also result from its ability to modify the structure of blood-brain barrier (BBB). The present study investigated the postmortem brain mRNA and immunohistochemical expressions of matrix metalloproteases (MMPs), claudin5 (CLDN5), and aquaporins (AQPs) in forensic autopsy cases of carbon monoxide (n = 14), METH (n = 21), and phenobarbital (n = 17) intoxication, compared with mechanical asphyxia (n = 15), brain injury (n = 11), non-brain injury (n = 21), and sharp instrument injury (n = 15) cases. Relative mRNA quantification using Taqman real-time PCR assay demonstrated higher expression of AQP4 and MMP9, lower expression of CLDN5 in METH intoxication cases and lower expression of MMP2 in phenobarbital intoxication cases. Immunostaining results showed substantial interindividual variations in each group, showing no evident differences in distribution or intensity among all the causes of death. These findings suggest that METH may increase BBB permeability by altering CLDN5 and MMP9, and the self-protective system maybe activated to eliminate accumulating water from the extracellular space of the brain by up-regulating AQP4. Systematic analysis of gene expressions using real-time PCR may be a useful procedure in forensic death investigation.

  4. 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.

  5. 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

  6. Giant hepatic metastasis in a patient with coin-like small cell lung carcinoma incidentally diagnosed at autopsy

    PubMed Central

    Fodor, Decebal; Gurzu, Simona; Contac, Anca Otilia; Jung, Ioan

    2017-01-01

    Abstract Rationale: Encephalopathy is a rare complication of hepatic metastases. In this paper we present a case of a patient with lung cancer and metastatic-related giant hepatomegaly. Patient concerns: A 78-year-old previously healthy male was admitted in the Emergency room in hepatic coma. Diagnoses: The abdominal CT scan examination revealed a huge liver filled with solid nodules. Interventions: No interventions were performed. Outcomes: The patient died at few hours after hospitalization. The autopsy showed a 6.5 kilograms liver with several whitish metastatic nodules and an occult prostate adenocarcinoma. The hilum of both lungs was free of tumor and a 10 mm white nodule was identified surrounding a small bronchus. No peripheral nodules were macroscopically identified. Under microscope, cluster of small cells were observed encasing a small bronchus with multiple minute coin-shaped subpleural foci. A massive intrapulmonary angiolymphatic invasion and metastases from small cell carcinoma in liver, lymph nodes and iliac crest bone marrow were also diagnosed. Lessons: This case highlights the difficulty of diagnosis of aggressive lung carcinomas and the necessity of checking for metachronous tumors. The encephalopathy might be the result of metastatic damage of the liver parenchyma combined with the paraneoplastic effect of the tumor cells. Few than 25 cases of SCLCs with diffuse liver metastases and fulminant liver failure were reported to December 2016. This is the first reported case with a synchronous prostate cancer and a “coin-like” aspect of the SCLC. PMID:28296775

  7. Richter’s Type of Incarcerated Obturator Hernia that Presented with a Deep Femoral Abscess: An Autopsy Case Report

    PubMed Central

    Yonekura, Satoru; Kodama, Masaaki; Murano, Shunichi; Kishi, Hirohisa; Toyoda, Akihiro

    2016-01-01

    Patient: Female, 89 Final Diagnosis: Obturator hernia Symptoms: Coxalgia • femoral abscess • gait disorder Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Richter’s obturator hernia is a rare abdominal hernia that is difficult to diagnose. The purpose of this case report is to show an unusual presentation of a fatal Richter’s obturator hernia that was accompanied by a femoral abscess. Case Report: An 89-year-old woman complained of sudden left coxalgia and a gait disorder but no abdominal symptoms. She had no history of trauma or surgery in the inguinal area. Twenty-three days after her first complaint of coxalgia, the patient was admitted in a coma with necrotizing fasciitis in the left inguinal area. The patient died of asystole due to hyperkalemia. During surveillance for the cause of death, a Richter’s type of incarcerated obturator hernia was identified at autopsy. The incarcerated small intestine had penetrated into the left obturator foramen to form an abscess that extended into the deep femoral region. Conclusions: Obturator hernia accompanied by femoral abscess is extremely rare, but it should be suspected when a patient with no history of trauma or surgery has a femoral abscess, even in the absence of abdominal symptoms. PMID:27818487

  8. Rupture of the spleen or splenic vessels (splenic emergency syndrome) in late pregnancy: a report of two autopsy cases.

    PubMed

    Di Vella, Giancarlo; Arpaio, Alessandra; Marzullo, Andrea; Colonna, Massimo

    2008-04-07

    Emergencies of splenic origin in pregnancy involving rupture of the splenic artery or hemorrhage are rare events that can present suddenly and unexpectedly. We report two cases of young women, both in the third trimester of gestation, who suffered sudden malaise while at home and were admitted to the ER. On arrival, both were in severe hemorrhagic shock due to gross hemoperitoneum and they died in the operating theatre during emergency surgery. To better clarify the causes and sequence of these mortalities, forensic autopsy was requested in each case. In the first (a 26-year-old primigravida in the 40th week of pregnancy), cadaveric section demonstrated the rupture of an aneurysm of the splenic artery. In the second (a 28-year-old multipara in the 33rd week of pregnancy), the clinical and anatomopathological data suggested splenic hemorrhage. In both cases histology showed a fibrodysplasia of the arterial wall involving the splenic artery in one case and the hilar branches in the other. In agreement with the data in literature, in such cases particular importance must be attributed to examination of the arterial wall. In pregnancy a synergic effect between hemodynamic and endocrine factors can cause degeneration of the arteries resulting in dramatic hemorrhage. From the forensic pathologist's viewpoint, these cases underline the importance of histopathological study of the splenic artery in the interpretation of the pathogenesis of splenic vessel rupture or hemorrhage.

  9. Surface analysis of pilot distribution system pipe autopsies: The relationship of organic and inorganic deposits to input water quality.

    PubMed

    Fabris, Rolando; Denman, John; Braun, Kalan; Ho, Lionel; Drikas, Mary

    2015-12-15

    Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) surface analysis was conducted to characterise deposits in polyethylene pipes used in a novel pilot water distribution system (PDS). The system consisted of four (4) parallel distribution systems receiving water from different treatment processes, ranging from conventional coagulation through to an advanced membrane filtration system. After two years of operation, the distribution system was shut down and samples of pipe were collected for autopsy analysis. Inlet and outlet samples from each PDS were collected for purpose of comparison. ToF-SIMS was used to assess chemical differences in surface biofilm accumulation and particulate deposition, which resulted as a consequence of the treatment method and operational mode of each system. These data supplemented previously collected bacteriological and chemical water quality data. Results from the inorganic analysis of the pipes were consistent with corrosion and contamination events that occurred upstream in the corresponding treatment systems. Principal component analysis of data on organic constituents showed oxygen and nitrogen containing fragments were associated with the treatment inlet and outlet samples. These types of signals can often be ascribed to biofilm polysaccharides and proteins. A trend was observed when comparing samples from the same PDS, showing an association of lower molecular weight (MW) organic fragments with the inlet and higher MW organic fragments with the outlet samples.

  10. Pathological autopsy of a patient that underwent a successful ablation of an electrical storm from the left ventricular summit.

    PubMed

    Hori, Yuichi; Nakahara, Shiro; Mine, Sohtaro; Anjo, Naofumi; Fujii, Akiko; Ueda, Yoshihiko; Taguchi, Isao

    2016-12-01

    A 65-year-old man with non-ischemic cardiomyopathy, underwent an autopsy 2 months after the successful ablation of a sustained left ventricular (LV) summit ventricular tachycardia (VT). The patient died due to interstitial pneumonia from amiodarone use. The earliest activation sites of the VT were documented from both inside the anterior interventricular vein (AIV) and epicardial surface. The diameter of the AIV was 3-4 mm, and the radiofrequency (RF) lesion inside the AIV was a slight lesion due to high impedance with a high temperature. The lesion from the epicardial surface was also superficial and insufficient due to neighboring coronary arteries and the existence of epicardial fat. A successful application was performed from the LV endocardium, and diffuse myocardial fibrosis was observed in the mid-myocardium including inside the RF lesions. The actual relationship between the myocardial fibrosis and LV summit VT remains unclear, but this case showed the difficulty of achieving a successful ablation from the epicardial side, when the focus exists in the mid-myocardium around the LV summit.

  11. A socio-ecological autopsy of the E. coli O157:H7 outbreak in Walkerton, Ontario, Canada.

    PubMed

    Ali, S Harris

    2004-06-01

    The socio-political context of modern environmental health disasters tends to be defined as being outside the scope of official public health and epidemiological investigations into the causes of such disasters. On the other hand, popular accounts of these disasters tend to focus exclusively on the role of particular individuals and/or political actors, while minimizing the role of ecological factors. It is argued that an exclusive focus on either set of causal factors gives an incomplete or distorted picture of the origins of an environmental health disaster. In this paper, a socio-ecological analysis is developed to demonstrate how the largest outbreak of waterborne E. coli O157:H7 in Canadian history was the emergent product of a complex interplay and intertwining of social and ecological processes. The socio-ecological autopsy approach that is developed here traces the social and ecological chain of events that ultimately led to the outbreak and demonstrates, in particular, the need for investigative analysis to focus on the socio-ecological "incubation" of an environmental health disaster. Drawing from both the social sciences (particularly, the sociology of disasters and organizational sociology), and from the ecological sciences (particularly disease ecology), the analysis developed here responds to the call for the application of a more transdisciplinary approach to the study of contemporary environmental health problems.

  12. Upstream transcription factor 1 (USF1) polymorphisms associate with Alzheimer's disease-related neuropathological lesions: Tampere Autopsy Study.

    PubMed

    Isotalo, Karita; Kok, Eloise Helena; Luoto, Teemu M; Haikonen, Satu; Haapasalo, Hannu; Lehtimäki, Terho; Karhunen, Pekka J

    2012-11-01

    The apolipoprotein E (APOE) gene associates with Alzheimer's disease (AD) and cholesterol levels. Upstream transcription factor 1 (USF1) regulates lipid metabolism genes, including APOE, and the AD Aβ-precursor protein. We investigated associations between 6 haplotype-tagging USF1 single-nucleotide polymorphisms (and haplotypes) and AD-related neuropathological lesions [senile plaques (SP), neurofibrillary tangles (NFT) ] in an autopsy series comprising 603 cases (ages 0-97, mean 62 years, 215 women) that died out-of-hospital. In age- and APOE-adjusted analyses, the minor G-allele of rs2774276, previously linked to elevated cholesterol, associated with late-stage burnt out SP among women and early non-neuritic SP among men. The G-allele of the previously unreported rs10908821 showed significant risk of having SP, especially neuritic and burnt out SP, among women but not men. USF1 haplotype GCGCAC carriers (risk alleles of rs2774276 and rs10908821) associated with SP risk, especially neuritic and late-stage burnt out SP, among women but not men. Younger CCGCAC carriers (risk allele of rs2774276 and protective of rs10908821) were more likely to have non-neuritic and diffuse SP. Conversely, USF1 CCGCAC haplotype carriers had lower NFT prevalence among 65+ year-olds. These results suggest USF1 has an independent but gender- and age-associated effect on AD-related brain lesion development.

  13. An approach to dissecting the congenitally malformed heart in the forensic autopsy: the value of sequential segmental analysis.

    PubMed

    Horn, K D; Devine, W A

    2001-12-01

    The demonstration of congenital heart disease at autopsy necessitates the careful preservation and examination of the heart, the vessels, and their connections. Techniques preserving these connections and using a reproducible and systematic approach are preferred. The Rokitansky method of organ block dissection, in combination with a system of heart examination termed sequential segmental analysis, provides such an approach. This study is based on the examination of heart specimens accessioned into the Frank E. Sherman, M.D., and Cora C. Lenox, M.D., Heart Museum (containing approximately 2400 specimens) of the Pathology Department, Children's Hospital of Pittsburgh. Specimens received in consultation during a 25-year period from hospitals and coroners'/medical examiners' offices were examined, and the corresponding reports were reviewed. Of 46 total heart specimens examined (1975-1999), 29 (63%) were dissected properly or left intact for dissection at Children's Hospital of Pittsburgh, and 17 (37%) were incorrectly dissected for the demonstration of congenital heart disease. Of these 17 cases, 11 (24%) displayed dissection errors, which did not hinder a complete diagnosis, 3 cases (6.5%) had errors that enabled only an incomplete diagnosis, and in 3 cases (6.5%), no diagnosis of congenital heart disease could be made. Dissection mistakes and means of avoiding them are discussed. Review of medical and family history, external and internal examination, and a reproducible and sequential method of examining the heart and its connections enables documentation of even the most complex cardiovascular anomalies.

  14. Medico-legal autopsy of 1355 unclaimed dead bodies brought to a tertiary care hospital in Delhi, India (2006-2012).

    PubMed

    Saurav, Chopra; Aayushi, Garg; Behera, C; Karthik, Krishna; Millo, T; Gupta, Sk

    2014-09-01

    In India, it is estimated that about 13 million people are homeless. As these individuals have no close acquaintances, in the event of death, their bodies remain unclaimed. These unclaimed corpses pose a major challenge for the local law enforcement agencies in identification and thus become an obstacle in solving the cases of missing persons. We sought to review the autopsy characteristics and causes of death in the unclaimed/unidentified bodies autopsied at the All India Institute of Medical Sciences (AIIMS) from 2006 to 2012. Among the total of 11,786 cases autopsied during the year 2006 to 2012, 1335 (11%) were unclaimed. Most of the cases were males (91%) with a male-to-female ratio of 9:1. Mean age of the cohort was 43 years (range, 1-85 years). Natural events were the foremost cause of death and were more commonly seen in males. While accidental, suicidal and homicidal modes were common in younger age groups; natural manner of death predominated in the elderly. Most of the cases were found dead on the roadside. This paper also compares with the previous study in the same set-up during the time period 2001 to 2005. The authors believe that knowledge about the existing healthcare facilities need to be reinforced and their utilisation promoted.

  15. Postmortem virtual volumetry of the heart and lung in situ using CT data for investigating terminal cardiopulmonary pathophysiology in forensic autopsy.

    PubMed

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

    2014-07-01

    Postmortem CT (PM-CT) is useful to investigate the viscera in situ before opening the body cavity at autopsy. The present study investigated heart and lung volumes in situ with regard to the cause of death as possible indexes of terminal cardiopulmonary dysfunction by means of PM-CT data analysis of forensic autopsy cases within 3 days postmortem (n=70). Estimated heart volume was larger in sudden cardiac death (SCD; n=10) and fatal methamphetamine abuse (n=5) than in other groups, including mechanical asphyxiation (n=12), drowning (n=11), acute alcohol/sedative-hypnotic intoxication (n=8), fire fatality (n=12), hyperthermia (heatstroke; n=6) and fatal hypothermia (cold exposure; n=6). Estimated combined lung volume was larger in drowning, smaller in fire fatality due to carbon monoxide intoxication and SCD, and intermediate in other groups. Volume ratio of the lung to heart was higher in drowning, lower in SCD, and intermediate or varied in other groups; high and low ratios can indicate predominant/antecedent pulmonary and cardiac dysfunctions, respectively. These findings provide quantitative data that are not available at conventional autopsy or by routine two-dimensional CT morphology to assess three-dimensional gross heart and lung morphologies for interpreting terminal cardiopulmonary pathophysiology, detecting significant difference between SCD and other causes of death, especially mechanical asphyxiation and drowning.

  16. Incorporation of Autopsy Case-Based Learning into PhD Graduate Education: a Novel Approach to Bridging the 'Bench to Bedside' Gap.

    PubMed

    Brooks, Erin G; Thornton, Joanne M; Ranheim, Erik A; Fabry, Zsuzsanna

    2017-03-15

    Given the current rapid expansion of biological knowledge and the challenges of translating that knowledge into clinical practice, finding effective methods of teaching graduate students clinical medicine concepts has become even more critical. The utility of autopsy in medical student and resident education has been well-established. Multiple studies have reported it to be a helpful means of teaching anatomy, pathophysiology, clinical problem-solving skills, and medical diagnostic techniques. While various models of training Ph.D. candidates in clinical medicine have been reported, an autopsy-based curriculum has not been previously described. For over four years, our pathology department has offered a novel semester-long autopsy-based course to educate future Cellular and Molecular Pathology (CMP) scientists about clinical medicine. Our results indicating that this 'hands-on' approach is a popular as well as effective means of teaching the pathogenesis of disease at the level of the cell, organ, and patient. The course reputation has recently led to requests to open registration to graduate students from other university programs as well as undergraduate students. Additionally, it has played an important role in our CMP program's recent receipt of a 5-year renewal National Institutes of Health funded T32 award. Overall, this course model has been successful at our own institution, and could provide a useful template for other institutions seeking to provide graduate investigators with in-depth exposure to clinical medicine.

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

    PubMed

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

    2015-05-01

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

  18. Hodgkin-like peripheral T-cell lymphoma (PTCL) with preserved Hodgkin-like lesions at autopsy: a case report with an interesting clinical course.

    PubMed

    Mori, Daisuke; Matsuishi, Eijo; Akashi, Michiaki; Shibaki, Masami; Hirano, Takayuki; Ide, Mikiko; Tsutsumi, Yoko; Tsukiji, Hidenori; Gondo, Hisashi

    2015-01-01

    The presence of the so-called Hodgkin and Reed-Sternberg (H-RS) like cells may occur in T-cell non-Hodgkin lymphoma. Reported herein is the autopsy case of Hodgkin-like peripheral T-cell lymphoma (PTCL) in a 77-year-old male with gradual submandibular lymph node enlargement. The first biopsy showed Hodgkin-like PTCL, initially misdiagnosed as classical Hodgkin lymphoma. Although he was treated with a regimen of ABVD, his disease recurred with cervical lymph node enlargement. A second biopsy showed angioimmunoblastic T-cell lymphoma (AITL) and H-RS like cells became obscure. Despite treatment with the CHOP regimen, he died. An autopsy confirmed that only Hodgkin-like lesions preserved while the AITL component had disappeared. This clinical course is very interesting in that only the Hodgkin-like lesions were systematically exacerbated and became the main cause of death. There are no reports of Hodgkin-like PTCL following AITL and finally preserved Hodgkin-like lesions in autopsy.

  19. In vivo compartmentalization of human immunodeficiency virus: evidence from the examination of pol sequences from autopsy tissues.

    PubMed Central

    Wong, J K; Ignacio, C C; Torriani, F; Havlir, D; Fitch, N J; Richman, D D

    1997-01-01

    High rates of mutation and replication of human immunodeficiency virus (HIV) allow for the continuous generation of diverse genetic variants in vivo. Selective pressures within the microenvironments of different anatomic compartments result in the emergence of dominant quasispecies which can be distinguished by their envelope sequences. It is not known whether comparable tissue-specific selective pressures lead to the independent evolution of pol sequences within different tissue compartments, nor is it known how differing rates of virus turnover in tissues might affect the pace of such evolution. These issues are of importance for the formulation of a model for the emergence of drug resistance in vivo and for a general understanding of virus trafficking and virus turnover. Regions of the HIV type 1 reverse transcriptase (RT) which carry the majority of the known resistance codons to RT inhibitors (700 nucleotides from each clone) were cloned and sequenced directly from autopsied brain, spleen, and lymph node specimens from four subjects who had received zidovudine therapy. Clones from proviral DNA (143) and from viral cDNA (14) were analyzed. In three of four subjects, a discordance in distribution of resistance codons was noted. Moreover, brain-derived sequences appeared to be phylogenetically distinct from spleen- and lymph node-derived sequences even after exclusion of resistance codons from analysis. In each case, evidence for differential immune selective pressure, based on comparison of inferred amino acid sequences corresponding to known major histocompatibility complex class I cytotoxic T-lymphocyte epitopes, was found. These observations support the concept of anatomically distinct, independently evolving quasispecies (virodemes). PMID:9032338

  20. Organochlorine pesticide levels in blood serum samples taken at autopsy from auto accident victims in Veracruz, Mexico.

    PubMed

    Waliszewski, Stefan M; Carvajal, Octavio; Infanzón, Rosa M; Gómez-Arroyo, Sandra; Villalobos-Pietrini, Rafael; Trujillo, Patricia; Hart, Mary Maxwell

    2004-09-01

    Samples of human blood sera (N = 118) for the determination of organochlorine pesticide levels were obtained at autopsy from auto accident victims in Veracruz, Mexico, during the years 2000 and 2001. The presence of hexachlorobenzene (HCH), beta-hexachlorocyclohexane (beta-HCH), 2,2-bis(p-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE), 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (p,p'-DDT), and o,p'-DDT was confirmed by gas-liquid-electron-capture detection chromatography. During the years 2000 and 2001, the respective mean levels of (a) HCB, (b) beta-HCH, (c) p,p'-DDE, (d) o,p'-DDT, (e) p,p'-DDT, and (f) total DDT were (a) 2.1 ng/ml and 1.4 ng/ml, (b) 3.0 ng/ml and 3.6 ng/ml, (c) 21.1 ng/ml and 23.8 ng/ml, (d) 1.2 ng/ml and 0.8 ng/ml, (e) 3.3 ng/ml and 2.5 ng/ml, and, finally, (f) 25.4 ng/ml and 27.1 ng/ml, respectively. High levels of persistent organochlorine pesticides were--and continue to be--present in the blood of individuals who live in Mexico. Levels of insecticide metabolites (e.g., beta-HCH, p,p'-DDE) in blood have increased during recent years (1997-2001), but levels of p,p'-DDT decreased in 2001 because the use of DDT for the control of malaria in Mexico was restricted.

  1. 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

  2. The human neurosecretory neurones under perinatal hypoxia: a quantitative immunohistochemical study of the supraoptic nucleus in autopsy material.

    PubMed

    Pagida, M A; Konstantinidou, A E; Malidelis, Y I; Ganou, V; Tsekoura, E; Patsouris, E; Panayotacopoulou, M T

    2013-12-01

    In the rat, experimental manipulations that cause activation of the magnocellular neurosecretory neurones result in the synthesis, in addition to vasopressin (AVP) and oxytocin (OXY), of other neurotransmitters or peptides, including tyrosine hydroxylase (TH), the first and rate limiting enzyme for catecholamine biosynthesis. In the human neonate, our previous study showed that TH was selectively increased in AVP neurones of subjects that died from prolonged perinatal hypoxia. The purpose of the present study was to quantitatively investigate the expression of TH, AVP, OXY and neurophysin in magnocellular neurones of the human neonate in relation to the severity/duration of perinatal hypoxia, as estimated by neuropathological criteria. Autopsy was performed after obtaining parental written consent for diagnostic and research purposes. The intensity of the immunohistochemical reactions and the cellular/nuclear size were measured in the dorsolateral supraoptic nucleus using a computerised image analysis system. We showed that prolonged perinatal hypoxia resulted in the activation of the magnocellular neuroendocrine neurones of the human neonate, as indicated by their increased neuronal and nuclear size. OXY neurones appeared larger than the AVP ones at birth, possibly indicating an active role of foetal OXY during labour or even earlier. The gradual increase in the duration of the insult resulted in the reduction of intracellular AVP content, in parallel with a dramatic increase in the expression of TH, indicating a functional interaction of these peptides under neuronal activation. Ιsolated evidence in our series, obtained from an infant of a diabetic mother, raises the probability that in the case of hyperglycaemia the above pathogenetic mechanisms are diversified.

  3. [Expression and significance of integrin α5β1 and fibronectin in atherosclerotic plaques from autopsy specimens].

    PubMed

    Yu, X; Zhang, Q Q; Wang, B; Sun, L

    2017-03-08

    Objective: To investigate the expression of integrin α5β1 and fibronectin in the human aorta and coronary artery, and their effects in the development of atherosclerosis. Methods: One hundred and twenty autopsy aorta and coronary artery specimens were collected, and the expression of CD68, actin, integrin α5β1 and fibronectin was detected by immunohistochemical staining. Atherosclerotic plaques were located by CD68 and actin staining, and the degree of coronary artery stenosis was determined by elastic fiber staining and NIH Scion Image(60.1) software. The coronary artery tissues were divided into groups A (0-25%); B (26%-50%); C (51%-75%) and D (76%-100%) according to the degree of stenosis. Results: Integrin α5β1 showed cytoplasmic expression in endothelium, foam cells, monocytes, smooth muscle cells and adjacent tissue around calcification. In both the aorta and coronary artery, integrin α5β1 expression was stronger in the smooth muscle cells in the internal elastic lamina than in the tunica. The expression intensity in coronary artery smooth muscle decreased with increasing degree of coronary artery stenosis. Fibronectin showed cytoplasmic expression in foam cells, monocytes, smooth muscle cells of the internal elastic lamina and adjacent tissue around calcification. There was positive correlation of fibronectin and integrin α5β1 expression in smooth muscle cells and adjacent tissue around calcification. Conclusions: In the development of atherosclerosis, integrin α5β1 and fibronectin may participate in the regulating the migration of smooth muscle cells to the intima, and promote the formation of local calcification of atherosclerotic plaques. But integrin α5β1 is not involved in the late stage of atherosclerosis with increasing coronary artery stenosis.

  4. 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

  5. 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

  6. 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.

  7. Verbal autopsy: an analysis of the common causes of childhood death in the Barekese sub-district of Ghana

    PubMed Central

    Manortey, Stephen; Carey, Adrienne; Ansong, Daniel; Harvey, Ryan; Good, Brian; Boaheng, Joseph; Crookston, Benjamin; Dickerson, Ty

    2011-01-01

    The availability of mortality data for any society plays an essential role in health monitoring and evaluation, as well as in the design of health interventions. However, most resource-poor countries such as Ghana have no reliable vital registration system. In these instances, verbal autopsy (VA) may be used as an alternative method to gather mortality data. In rural Ghana, the research team utilized a VA questionnaire to interview caretakers who were present with a child under the age of five prior to death. The data was given to two physicians who independently assigned the most probable cause of death for the child. A third, blinded physician analyzed the data in the cases where the first two physicians disagreed. When there was agreement between physicians, this was assigned as the cause of death for the individual child. During the study period, we recorded 118 deaths from 92 households. Twenty-nine (24.6%) were neonatal deaths with the leading causes of death being neonatal sepsis, birth asphyxia and pneumonia. The remaining 89 (75.4%) were post-neonatal deaths with the most common causes of death being pneumonia, malaria and malnutrition. While 63/118 (53.4%) deaths occurred in the home, there is no statistically significant relationship between the location of the home and the time of travel to the nearest health facility (P=0.132). VA is an important epidemiological tool for obtaining mortality data in communities that lack reliable vital registration systems. Improvement in health care is necessary to address the large number of deaths occurring in the home. PMID:28299059

  8. Morphine to codeine concentration ratio in blood and urine as a marker of illicit heroin use in forensic autopsy samples.

    PubMed

    Konstantinova, Svetlana V; Normann, Per T; Arnestad, Marianne; Karinen, Ritva; Christophersen, Asbjørg S; Mørland, Jørg

    2012-04-10

    A morphine to codeine ratio greater than unity (M/C>1) has been suggested as an indicator of heroin use in living individuals. The aim of this study was to examine the morphine to codeine ratio in a large population (N=2438) of forensically examined autopsy cases positive for 6-monoacetylmorphine (6-MAM) and/or morphine in blood and/or urine. Blood and urine concentrations of 6-MAM, morphine and codeine were examined using GC-MS and LC-MS/MS methods. In 6-MAM positive samples, the M/C ratio was greater than unity in 98% (N=917) of the blood samples and 96% (N=665) of the urine samples. Stratification of 6-MAM negative cases by M/C above or below unity revealed similarities in morphine and codeine concentrations in cases where M/C>1 and 6-MAM positive cases. Median blood and urine morphine concentrations were 8-10 times greater than codeine for both groups. Similarly to 6-MAM positive cases, 25-44 year-old men prevailed in the M/C>1 group. In comparison to cases where M/C ≤ 1, the M/C ratio was a hundred times higher in both 6-MAM positive and M/C>1 cases. The range of morphine concentration between the lowest and the highest quintile of codeine in M/C>1 cases was similar to that in 6-MAM positive cases. This range was much higher than for M/C ≤ 1 cases. Moreover, linear regression analyses, adjusted for age and gender, revealed a strong positive association between morphine and codeine in 6-MAM positive and M/C>1 cases. The M/C ratio appeared to be a good marker of heroin use in post-mortem cases. Both blood and urine M/C>1 can be used to separate heroin users from other cases positive for morphine and codeine.

  9. Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations

    PubMed Central

    de Savigny, Don; Riley, Ian; Chandramohan, Daniel; Odhiambo, Frank; Nichols, Erin; Notzon, Sam; AbouZahr, Carla; Mitra, Raj; Cobos Muñoz, Daniel; Firth, Sonja; Maire, Nicolas; Sankoh, Osman; Bronson, Gay; Setel, Philip; Byass, Peter; Jakob, Robert; Boerma, Ties; Lopez, Alan D.

    2017-01-01

    ABSTRACT Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance. Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems. PMID:28137194

  10. Quantitative evaluation of volatile hydrocarbons in post-mortem blood in forensic autopsy cases of fire-related deaths.

    PubMed

    Yonemitsu, Kosei; Sasao, Ako; Oshima, Toru; Mimasaka, Sohtaro; Ohtsu, Yuki; Nishitani, Yoko

    2012-04-10

    Volatile hydrocarbons in post-mortem blood from victims of fires were analyzed quantitatively by headspace gas chromatography mass spectrometry. The benzene and styrene concentrations in the blood were positively correlated with the carboxyhemoglobin (CO-Hb) concentration, which is evidence that the deceased inhaled the hydrocarbons and carbon monoxide simultaneously. By contrast, the concentrations of toluene and CO-Hb in the blood were not significantly correlated. This lack of correlation could be explained by two different sources of toluene, with low blood concentrations of toluene arising when the deceased inhaled smoke and high blood concentrations of toluene arising when the deceased inhaled petroleum vapor or other unknown vapors. The quantity of soot deposited in the respiratory tract was classified into four grades (-, 1+, 2+, 3+). The mean CO-Hb concentration in the 1+ soot group was significantly lower than those in the 2+ (p<0.05) and 3+ (p<0.01) soot groups. The blood CO-Hb concentrations in the 1+ soot group were all below 30%. Those indicated that the deceased aspirated smoke that contained both soot and carbon monoxide. The wide variation in CO-Hb concentrations for each soot classification could be caused by the different types of smoke produced by different materials. For example, petroleum combustion with a limited supply of oxygen, like in a compartment fire, may produce a large volume of dense black smoke that contains a large quantity of soot. Soot deposits in the airways and the blood CO-Hb concentration are basic and essential autopsy findings that are used to investigate fire-related deaths. The quantitative GC-MS analysis of blood volatile hydrocarbons can provide additional useful information on the cause of the fire and the circumstances surrounding the death. In combination, these three findings are useful for the reconstruction of cases.

  11. EtG and EtS in Autopsy Blood Samples With and Without Putrefaction Using UPLC-MS-MS.

    PubMed

    Hegstad, Solfrid; Kristoffersen, Lena; Liane, Veronica H; Spigset, Olav

    2017-03-01

    Analytical challenges related to postmortem specimens are well known. The degree of putrefaction of the corpse will influence the quality of the blood samples, and both the efficiency of sample preparation and the subsequent chromatographic performance can be affected. An ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) method was developed and validated for the determination of ethyl glucuronide (EtG) and ethyl sulfate (EtS) in postmortem whole blood. Sample preparation prior to UPLC-MS-MS analysis consisted of protein precipitation and filtration through a phospholipid removal plate. Chromatography was achieved using an HSS T3 column and gradient elution with formic acid in water in combination with methanol. The injection volume was 0.5 µL. Negative electrospray ionization was performed in the multiple reaction monitoring mode. Two transitions were monitored for the analytes and one for the internal standards. The between-assay relative standard deviations were in the range of 1.7-7.0% and the limits of quantification were 0.025 and 0.009 mg/L for EtG and EtS, respectively. Recovery was 51-55% and matrix effects ranged from 98% to 106% (corrected with internal standard). Blood samples from nine autopsy cases with various extents of putrefaction were analyzed. The sample preparation efficiently removed the phospholipids from the blood specimens. The samples were clean and the analytical quality of the chromatographic performance was satisfactory for both analytes irrespective of the degree of putrefaction.

  12. 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.

  13. 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.

  14. HIV DNA Is Frequently Present within Pathologic Tissues Evaluated at Autopsy from Combined Antiretroviral Therapy-Treated Patients with Undetectable Viral Loads

    PubMed Central

    Lamers, Susanna L.; Rose, Rebecca; Maidji, Ekaterina; Agsalda-Garcia, Melissa; Nolan, David J.; Fogel, Gary B.; Salemi, Marco; Garcia, Debra L.; Bracci, Paige; Yong, William; Commins, Deborah; Said, Jonathan; Khanlou, Negar; Hinkin, Charles H.; Sueiras, Miguel Valdes; Mathisen, Glenn; Donovan, Suzanne; Shiramizu, Bruce; Stoddart, Cheryl A.; Singer, Elyse J.

    2016-01-01

    ABSTRACT HIV infection treatment strategies have historically defined effectiveness through measuring patient plasma HIV RNA. While combined antiretroviral therapy (cART) can reduce plasma viral load (pVL) to undetectable levels, the degree that HIV is eliminated from other anatomical sites remains unclear. We investigated the HIV DNA levels in 229 varied autopsy tissues from 20 HIV-positive (HIV+) cART-treated study participants with low or undetectable plasma VL and cerebrospinal fluid (CSF) VL prior to death who were enrolled in the National Neurological AIDS Bank (NNAB) longitudinal study and autopsy cohort. Extensive medical histories were obtained for each participant. Autopsy specimens, including at least six brain and nonbrain tissues per participant, were reviewed by study pathologists. HIV DNA, measured in tissues by quantitative and droplet digital PCR, was identified in 48/87 brain tissues and 82/142 nonbrain tissues at levels >200 HIV copies/million cell equivalents. No participant was found to be completely free of tissue HIV. Parallel sequencing studies from some tissues recovered intact HIV DNA and RNA. Abnormal histological findings were identified in all participants, especially in brain, spleen, lung, lymph node, liver, aorta, and kidney. All brain tissues demonstrated some degree of pathology. Ninety-five percent of participants had some degree of atherosclerosis, and 75% of participants died with cancer. This study assists in characterizing the anatomical locations of HIV, in particular, macrophage-rich tissues, such as the central nervous system (CNS) and testis. Additional studies are needed to determine if the HIV recovered from tissues promotes the pathogenesis of inflammatory diseases, such as HIV-associated neurocognitive disorders, cancer, and atherosclerosis. IMPORTANCE It is well-known that combined antiretroviral therapy (cART) can reduce plasma HIV to undetectable levels; however, cART cannot completely clear HIV infection. An

  15. Autopsy Prevalence of Tuberculosis and Other Potentially Treatable Infections among Adults with Advanced HIV Enrolled in Out-Patient Care in South Africa

    PubMed Central

    Omar, Tanvier; von Gottberg, Anne; Tlali, Mpho; Chihota, Violet N.; Churchyard, Gavin J.; Fielding, Katherine L.; Johnson, Suzanne; Martinson, Neil A.; McCarthy, Kerrigan; Wolter, Nicole; Wong, Emily B.; Charalambous, Salome; Grant, Alison D.

    2016-01-01

    Background Early mortality among HIV-positive adults starting antiretroviral therapy (ART) remains high in resource-limited settings, with tuberculosis (TB) the leading cause of death. However, current methods to estimate TB-related deaths are inadequate and most autopsy studies do not adequately represent those attending primary health clinics (PHCs). This study aimed to determine the autopsy prevalence of TB and other infections in adults enrolled at South African PHCs in the context of a pragmatic trial of empiric TB treatment (“TB Fast Track”). Methods and Findings Adults with CD4 ≤150 cells/μL, not on ART or TB treatment, were enrolled to TB Fast Track and followed up for at least six months. Minimally invasive autopsy (MIA) was conducted as soon as possible after death. Lungs, liver, and spleen were biopsied; blood, CSF, and urine aspirated; and bronchoalveolar lavage fluid obtained. Samples underwent mycobacterial, bacterial, and fungal culture; molecular testing (including Xpert® MTB/RIF); and histological examination. 34 MIAs were conducted: 18 (53%) decedents were female; median age was 39 (interquartile range 33–44) years; 25 (74%) deaths occurred in hospitals; median time from death to MIA was five (IQR 3–6) days. 16/34 (47%) had evidence of TB (14/16 [88%] with extrapulmonary disease; 6/16 [38%] not started on treatment antemortem); 23 (68%) had clinically important bacterial infections; four (12%) cryptococcal disease; three (9%) non-tuberculous mycobacterial disease; and two (6%) Pneumocystis pneumonia. Twenty decedents (59%) had evidence of two or more concurrent infections; 9/16 (56%) individuals with TB had evidence of bacterial disease and two (13%) cryptococcal disease. Conclusions TB, followed by bacterial infections, were the leading findings at autopsy among adults with advanced HIV enrolled from primary care clinics. To reduce mortality, strategies are needed to identify and direct those at highest risk into a structured pathway

  16. [Extracranial metastases of brain tumors--a case report and survey of patients with extracranial metastasis sampled from a report on pathological autopsy cases in Japan].

    PubMed

    Nakamura, K; Hawkin, S; Aizawa, M; Maekubo, H; Kobayashi, N; Ozasa, T; Kunieda, Y; Hokari, I; Matsushima, T; Miyazaki, T

    1986-03-01

    A 36-year-old man who suffered from recurrence of hemangiopericytoma originating in the cerebellar tentorium and multiple extracranial metastasis over 14 years was reported. Analysis of the 104 cases of extracranial metastasis sampled from the Annual of the Pathological Autopsy Cases in Japan revealed that the frequency of extracranial metastasis is 3.8% of all brain tumors. Extracranial metastasis was frequently found in medulloblastoma, glioblastoma multiforme, malignant meningioma and ependymoma. Organs of frequent metastasis were the lung, bone, liver, pleura, and kidney. Bone metastasis was especially frequent in the vertebra.

  17. Sociodemographic, behavioral, and environmental factors of child mortality in Eastern Region of Cameroon: results from a social autopsy study

    PubMed Central

    Koffi, Alain K; Wounang, Romain S; Nguefack, Félicitée; Moluh, Seidou; Libite, Paul–Roger; Kalter, Henry D

    2017-01-01

    Background While most child deaths are caused by highly preventable and treatable diseases such as pneumonia, diarrhea, and malaria, several sociodemographic, cultural and health system factors work against children surviving from these diseases. Methods A retrospective verbal/social autopsy survey was conducted in 2012 to measure the biological causes and social determinants of under–five years old deaths from 2007 to 2010 in Doume, Nguelemendouka, and Abong–Mbang health districts in the Eastern Region of Cameroon. The present study sought to identify important sociodemographic and household characteristics of the 1–59 month old deaths, including the coverage of key preventive indicators of normal child care, and illness recognition and care–seeking for the children along the Pathway to Survival model. Findings Of the 635 deceased children with a completed interview, just 26.8% and 11.2% lived in households with an improved source of drinking water and sanitation, respectively. Almost all of the households (96.1%) used firewood for cooking, and 79.2% (n = 187) of the 236 mothers who cooked inside their home usually had their children beside them when they cooked. When 614 of the children became fatally ill, the majority (83.7%) of caregivers sought or tried to seek formal health care, but with a median delay of 2 days from illness onset to the decision to seek formal care. As a result, many (n = 111) children were taken for care only after their illness progressed from mild or moderate to severe. The main barriers to accessing the formal health system were the expenses for transportation, health care and other related costs. Conclusions The most common social factors that contributed to the deaths of 1–59–month old children in the study setting included poor living conditions, prevailing customs that led to exposure to indoor smoke, and health–related behaviors such as delaying the decision to seek care. Increasing caregivers’ ability to

  18. Autopsy of high-pressure membranes to compare effectiveness of MF and UF pretreatment in water reclamation.

    PubMed

    Kim, Jeonghwan; DiGiano, Francis A; Reardon, Roderick D

    2008-02-01

    A pilot-plant study was designed to compare the effectiveness of microfiltration (MF) and ultrafiltration (UF) as pretreatment for high-pressure membranes in reclamation of biologically treated wastewater effluent. Granular media, filtered secondary effluent from a full-scale wastewater treatment plant, was fed to MF and UF units that operated in parallel. Each of these filtrates served as the feedwater to two reverse osmosis (RO) units and one nanofiltration (NF) unit that operated in parallel. The decline in specific flux was substantially lower for high-pressure membranes receiving UF than MF pretreatment over the course of each of four pilot plant runs that lasted from 1 to 7 weeks. The removal of organic matter as measured by dissolved organic carbon (DOC) was somewhat higher by UF than MF pretreatment (about 15% by UF compared with 11% by MF). Addition of ferric chloride ahead of the UF unit, but not ahead of the MF unit, may account for this additional removal of organic matter. However, the additional DOC removal appeared insufficient to explain the differential in foulant accumulation between high-pressure membranes receiving UF and MF pretreatment. Extensive autopsy analyses of these high-pressure membranes showed from 35% to 56% less organic carbon on those receiving UF rather than MF pretreatment. A more specific indicator of a differential in organic fouling was the accumulation of polysaccharides and this showed from 27% to 38% less on UF- than on MF-pretreated membranes. Yet another possible source of foulants is inorganic material given that the inorganic and organic weight percentages were nearly equal (56% vs. 44%) on the membrane surface. One specific source was aluminum added for phosphorus removal. Less fouling of high-pressure membranes pretreated by UF than MF could be due to the following: (1) a small, but very important, colloidal fouling fraction may have passed through MF but was rejected by UF pretreatment; (2) organic fouling was not

  19. 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.

  20. 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

  1. [Autopsy case of a patient with Charcot-Marie-Tooth disease type 1A and suspected chronic inflammatory demyelinating polyradiculoneuropathy, which was later diagnosed as amyotrophic lateral sclerosis].

    PubMed

    Higuchi, Yujiro; Sakiyama, Yusuke; Nishihira, Yasushi; Endo, Kazuhiro; Suwazono, Shugo; Suehara, Masahito

    2012-01-01

    We report an autopsy case of a 74-year-old man with late onset Charcot-Marie-Tooth disease type 1A (CMT1A) diagnosed by genetic screening, later associated with amyotrophic lateral sclerosis (ALS). At the age of 70 years, the patient was admitted to our hospital because of progressive weakness and dysesthesia in the right upper limb. In the early stages of the illness, he was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and transient improvement was achieved with intravenous immunoglobulin. However, the symptoms progressively worsened and became refractory. Gene analysis revealed PMP22 gene duplication, which confirmed CMT1A. On sural nerve biopsy, severe demyelinating neuropathy and abundant onion-bulb formations with endoneurial infiltration of inflammatory cells were observed. Thereafter, pseudo-bulbar palsy and respiratory muscle weakness developed insidiously and progressed rapidly along with muscle weakness in the limbs and trunk. The patient died about four years after the onset of this disease. Postmortem examination showed moderate neuronal cell loss, Bunina bodies, and TDP-43-positive inclusions in the anterior horn cells. The spinal cord revealed axonal loss and extensive macrophage permeation in the corticospinal tracts. On the basis of these findings, the final neuropathological diagnosis was ALS. This is the first report of an autopsy case of CMT1A complicated with ALS. We here discuss the significant clinical and neuropathological findings of this case.

  2. Post-mortem alcohol analysis in synovial fluid: an alternative method for estimation of blood alcohol level in medico-legal autopsies?

    PubMed

    Büyük, Yalçin; Eke, Murat; Cagdir, A Sadi; Karaaslan, Hicran K

    2009-06-01

    To evaluate the effectiveness of synovial fluid alcohol concentration in prediction of blood alcohol concentration, synovial fluid and blood was studied of 50 autopsy cases and the alcohol levels determined by using Head Space Gas Chromatography method. To exclude the effect of decomposition on alcohol levels, corpses with post-mortem intervals less than 24 hours and not showing signs of decomposition were selected. Of 50 cases, alcohol was detected in 15 cases both in blood and in synovial fluid. In 35 cases alcohol analysis was negative both in blood and synovial fluid. No false positive results were seen in terms of synovial fluid. In two of the 15 cases, the alcohol determined was methyl alcohol and in others the alcohol was ethyl alcohol. In these 15 cases, only in one case was SAC level lower than the BAC level, and in 14 cases; SAC levels were higher than those of BAC. BAC (Blood Alcohol Concentration)/SAC (Synovial Fluid Alcohol Concentration) ratios were determined, and in 13 ethanol cases the mean ratio was determined to be 0.95 (0.90 +/- 0.07). The regression analysis showed a fairly linear relationship between the BAC and SAC, with a correlation coefficient of 0.984 (y = 0.86x + 10.4). The present study demonstrates that the synovial fluid is a valuable body fluid that can be used in prediction of blood alcohol concentration in forensic autopsy cases in which blood can not be properly obtained.

  3. Coexistence of amyotrophic lateral sclerosis with neuro-Behçet's disease presenting as a longitudinally extensive spinal cord lesion: clinicopathologic features of an autopsied patient.

    PubMed

    Sato, Tomoe; Ouchi, Haruka; Shimbo, Junsuke; Sato, Aki; Yamazaki, Motoyoshi; Hashidate, Hideki; Igarashi, Shuichi; Kakita, Akiyoshi

    2014-04-01

    We report the clinical and autopsy features of a 65-year-old Japanese man who clinically exhibited overlap of both neuro-Behçet's disease (NBD) and amyotrophic lateral sclerosis (ALS). The patient had a HLA-B51 serotype, a recent history of uveitis and had suffered paraparesis, sensory and autonomic disturbance, frontal signs and tremor. A brain and spine MRI study revealed a longitudinally extensive thoracic cord (Th) lesion, but no apparent intracranial abnormalities. The lesion extended ventrally from Th4 to Th9, exhibiting low intensity on T1-weighted images, high intensity on T2-weighted and fluid-attenuated inversion recovery images and gadolinium enhancement. The patient's upper and lower motor neuron signs and sensory disturbance worsened and he died 16 months after admission. At autopsy, the spinal cord and brain exhibited characteristic histopathological features of both NBD and ALS, including chronic destruction of the ventral thoracic white and gray matter, perivascular lymphocytic infiltration, binucleated neurons, lower and upper motor neuron degeneration, Bunina bodies and skein-like inclusions. Although incidental coexistence of these rare disorders could occur in an individual, this case raises the possibility of a pathomechanistic association between NBD and ALS.

  4. The clinico-pathological conference, based upon Giovanni Battista Morgagni's legacy, remains of fundamental importance even in the era of the vanishing autopsy.

    PubMed

    Zampieri, Fabio; Rizzo, Stefania; Thiene, Gaetano; Basso, Cristina

    2015-09-01

    Walter Cannon and Richard Cabot inaugurated the clinico-pathological conference (CPC) at Harvard Medical School at the beginning of the twentieth century, but this approach to anatomo-clinical correlation was first introduced by Giovanni Battista Morgagni at the University of Padua in the eighteenth century. The CPC consists of the presentation of a clinical case, in which past and recent medical histories of the patient, with all relevant information about laboratory tests including biopsy results, therapy and, eventually in a fatal case, the autopsy, are discussed. This is done for an audience of trainees and all physicians involved in the care for the patient. The CPC is still in use in many academic hospitals, as a teaching tool not only for undergraduate and graduate medical trainees, but also for postgraduate continuous medical education, in spite of the progressively declining autopsy rate. CPCs represent the ideal occasion for fruitful discussion between the two "souls" of medicine, i.e., the clinical, with its focus on the patient, and the pathological, with its focus on understanding disease. To discontinue using them would be equal to denying that modern medicine originated in Morgagni's method.

  5. 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.

  6. Autopsy statistics on the relative frequency of acute myocardial infarction in the Japanese mental workers and the unemployed during the two oil-crises periods.

    PubMed

    Chang, N C; Kawai, S; Okada, R

    1989-03-20

    In order to investigate whether job induced emotional stress, arising from socioenvironmental disasters would act as a trigger for the onset of AMI, the author reviewed all pathological autopsies throughout Japan 15 years old and over. Data was obtained from publications of the "Annual of the Pathological Autopsy Cases in Japan" for the years 1966-1968 (a period of high economic growth), 1973-1975 (1974, the year of the first oil crisis), and 1978-1980 (1979, the year of the second oil crisis). Relative frequencies of AMI were significantly higher during the years of both oil crises than in both the preceding and following years (2.6% in 1973, 3.7% in 1974, 3.0% in 1975; 2.8% in 1978, 3.2% in 1979, and 2.0% in 1980), and in each of three years of the high economic growth period (1.9-2.2% in 1966-1968). The proportions of managers and officials among AMI victims were significantly higher in the years of both oil crises than in both the preceding and following years (13.4% in 1973, 17.5% in 1974, 12.5% in 1975; 11.6% in 1978, 15.8% in 1979, and 11.1% in 1980). Moreover, there was a significantly higher value in the year of first oil crisis than in each of three years of the high economic growth period (11.7-13.1% in 1966-1968). The proportions of "out of job" persons were also significantly higher in the years of both oil crises than in the preceding years (24.0% in 1973, 29.3% in 1974, 27.8% in 1975; 24.1% in 1978, 29.1% in 1979, and 27.4% in 1980). For 11,199 randomly selected autopsies, the proportions of AMI in the above two occupational groups were significantly higher in the years of both oil crises than in the preceding years. Moreover, the proportion of "out of job" persons was significantly higher in the year of first oil crisis than in each of three years of the high economic growth period. A similar trend was noted among professional and technical workers, with more AMI occurring in this group during the years of both oil crises than in both the preceding

  7. 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

  8. [The impact of methodology on the reported prevalence of thyroid pathology: comparison of two autopsy series from Switzerland performed with different methods].

    PubMed

    Fleischmann, A; Hardmeier, Th

    2004-06-09

    To investigate the impact of methodology on the detection and hence reported prevalence of pathological findings in thyroids, in the geographic area of Kt. Thurgau in Switzerland, we used two different methods in two consecutive autopsy series of 420 patients. In series A, the thyroids were sliced unfixed and only suspect lesions were examined histologically. In series B, the thyroids were fixed in formalin and sectioned in a standardized manner. At least one specimen per lobe was taken for histological examination. Series A revealed that five patients had adenomas, four malignant primary tumors, two metastases and four inflammatory changes in the thyroid. Series B detected ten patients with adenomas, eight with primary malignant tumors, eleven with metastases and twenty-eight with inflammatory changes in the thyroid. These differences were significant (p < 0.001). In conclusion, the methodology has an important impact on the detected prevalence of pathological findings in the thyroid.

  9. The first autopsied case of diffuse Lewy body disease (DLBD): re-examination by recent immunostaining methods: The 50th Anniversary of Japanese Society of Neuropathology.

    PubMed

    Kosaka, Kenji; Manabe, Yuta

    2010-10-01

    Materials from our first autopsied case of diffuse Lewy body disease (DLBD), that was originally reported in 1976, were re-examined using recent immunohistochemical methods. Lewy pathology consisting of Lewy bodies and Lewy neurites appeared much more marked with alpha-synuclein immunostaining than had been detected with classical stainings. This case and our other similar cases prompted us to propose the terms "Lewy body disease" in 1980 and "diffuse Lewy body disease" in 1984. We also reported in 1990 that DLBD was classified into two forms: a pure form and a common form. Based on these studies the term "dementia with Lewy bodies (DLB)" was proposed in 1996. Since 1980, we have insisted that DLB, Parkinson disease (PD), and PD with dementia (PDD) should be understood within the spectrum of Lewy body disease. This insistence has been recently accepted by the International Workshop and the International Working Group on DLB and PDD in 2005 and in 2006, respectively.

  10. Degree of abnormality is associated with rate of change in measures of beta-amyloid, glucose metabolism and cognition in an autopsy-verified Alzheimer's disease case.

    PubMed

    Almkvist, Ove; Kadir, Ahmadul; Nordberg, Agneta

    2015-01-01

    The degree of abnormality and rate of change in cognitive functions, positron emission tomography Pittsburg compound B (PET PIB), and fluorodeoxyglucose (FDG) measures were studied for 8 years in an autopsy-confirmed Alzheimer's disease (AD) patient, who died 61 years old (Mini-Mental State Examination (MMSE) score 7). At first encounter with medical care, the patient was very mildly demented (MMSE score 27). She had four cognitive assessments and two examinations with PET PIB and FDG in 23 bilateral brain regions. The onset of cognitive decline was retrospectively estimated to have started in the early forties. The degree of impairment was inversely related to the rate of decline. A similar relationship was seen between the rate of change and the level of abnormality in both PIB and FDG. To conclude, rate of change in cognition, PIB, and FDG was associated with the degree of abnormality.

  11. An autopsy case of acute cor pulmonale and paradoxical systemic embolism due to tumour cell microemboli in a patient with breast cancer.

    PubMed

    Uga, Sayuri; Ikeda, Shuntaro; Matsukage, Sho-ichi; Hamada, Mareomi

    2012-09-30

    A 62-year-old woman was admitted to our hospital because of severe respiratory distress. Diagnostic imaging studies suggested the existence of inexplicable cor pulmonale. Although we immediately sought the aetiology of her severe condition, she died suddenly on the fourth day after admission. Postmortem autopsy revealed tumour cell microemboli in the small pulmonary arteries. In addition, tumour cell embolisation identical to that in primary breast cancer cells was also observed in microvessels in systemic multiple organs, such as the liver, brain, kidneys, spleen, uterus, bone marrow and adrenal glands-with simultaneous findings of peripheral infarction. Systemic tumour cell embolism mediated through the patent foramen ovale superimposed on pulmonary tumour cell emboli (PTCE) is considered to be the mechanism underlying inexplicable cor pulmonale. The rapid aggravation of her condition terminated in death.

  12. Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.

    PubMed

    Nagai, T; Mukai, T; Takahashi, S; Takada, A; Saito, K; Harada, K; Mori, S; Abe, N

    2014-03-01

    Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death.

  13. 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.

  14. Myelopathy mimicking subacute combined degeneration in a Down syndrome patient with methotrexate treatment for B lymphoblastic leukemia: report of an autopsy case.

    PubMed

    Satomi, Kaishi; Yoshida, Mari; Matsuoka, Kentaro; Okita, Hajime; Hosoya, Yosuke; Shioda, Yoko; Kumagai, Masa-Aki; Mori, Tetsuya; Morishita, Yukio; Noguchi, Masayuki; Nakazawa, Atsuko

    2014-08-01

    We report clinicopathological features of a 23-year-old woman with Down syndrome (DS) presenting with subacute myelopathy treated with chemotherapy, including intravenous and intrathecal administration of methotrexate (MTX), and with allogenic bone-marrow transplantation for B lymphoblastic leukemia. Autopsy revealed severe demyelinating vacuolar myelopathy in the posterior and lateral columns of the spinal cord, associated with macrophage infiltration, marked axonal loss and some swollen axons. Pathological changes of posterior and lateral columns were observed from the medulla oblongata to lumbar cord. Proximal anterior and posterior roots were preserved. Cerebral white matter was relatively well preserved. There were no vascular lesions or meningeal dissemination of leukemia. Longitudinal extension of cord lesions was extensive, unlike typical cases of subacute combined degeneration (SACD), but distribution of lesions and histological findings were similar to that of SACD. DS patients show heightened sensitivity to MTX because of their genetic background. Risk factors for toxic myelopathy of DS are discussed, including delayed clearance of MTX despite normal renal function, alterations in MTX polyglutamation and enhanced folic acid depletion due to gene dosage effects of chromosome 21. Alteration of folate metabolism and/or vitamin B12 levels through intravenous or intrathecal administration of MTX might exist, although vitamin B12 and other essential nutrients were managed using intravenous hyperalimentation. To the best of our knowledge, this is the first report of an autopsy case that shows myelopathy mimicking SACD in a DS patient accompanied by B lymphoblastic leukemia. The case suggests a pathophysiological mechanism of MTX-related myelopathy in DS patients with B lymphoblastic leukemia mimicking SACD.

  15. Accuracy of Lipoarabinomannan and Xpert MTB/RIF Testing in Cerebrospinal Fluid To Diagnose Tuberculous Meningitis in an Autopsy Cohort of HIV-Infected Adults.

    PubMed

    Cox, Janneke A; Lukande, Robert L; Kalungi, Sam; Van Marck, Eric; Lammens, Martin; Van de Vijver, Koen; Kambugu, Andrew; Nelson, Ann M; Colebunders, Robert; Manabe, Yukari C

    2015-08-01

    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.

  16. Postmortem volumetric CT data analysis of pulmonary air/gas content with regard to the cause of death for investigating terminal respiratory function in forensic autopsy.

    PubMed

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

    2014-08-01

    Postmortem CT (PMCT) is useful to investigate air/gas distribution and content in body cavities and viscera. The present study investigated the procedure to estimate total lung air/gas content and aeration ratio as possible indices of terminal respiratory function, using three-dimensional (3-D) PMCT data analysis of forensic autopsy cases without putrefactive gas formation (within 3 days postmortem, n=75), and analyzed the volumetric data with regard to the cause of death. When 3-D bilateral lung images were reconstructed using an image analyzer, combined lung volume was larger in drowning (n=12) than in alcohol/sedative-hypnotic intoxication (n=8) and sudden cardiac death (SCD; n=10), and intermediate in other cases, including mechanical asphyxiation (n=12), fire fatalities due to burns (n=6) and carbon monoxide intoxication (n=7), fatal methamphetamine abuse (n=7), hyperthermia (heatstroke; n=6) and fatal hypothermia (cold exposure; n=7). Air/gas content of the lung as detected using HU interval between -2000 and -400 ('effective' lung aeration areas) and between -2000 and -191 (total lung aeration areas) as well as the ratios to total lung volume ('effective' and total lung aeration ratios, respectively) was higher in mechanical asphyxiation, drowning, fatal burns and hypothermia (cold exposure) than in SCD, and was intermediate in other cases. 'Effective' and total lung aeration ratios may be useful for comparisons between specific causes of death to discriminate between hypothermia (cold exposure) and drug intoxication, and between SCD and other causes of death, respectively. These findings provide interesting insights into potential efficacy of PMCT data analyses of lung volume and CT density as well as lung air/gas content and aeration ratio with regard to the cause of death, as possible indicators of terminal respiratory function, as part of virtual autopsy of the viscera in situ.

  17. 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.

  18. 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

  19. 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.

  20. Suicide by antidepressant intoxication identified at autopsy in Vienna from 1991-1997: the favourable consequences of the increasing use of SSRIs.

    PubMed

    Frey, R; Schreinzer, D; Stimpfl, T; Vycudilik, W; Berzlanovich, A; Kasper, S

    2000-03-01

    In the area of Vienna, any person dying under questionable circumstances is examined at the Institute of Forensic Medicine, where the cause of death is determined by means of autopsy and chemical analysis. Our study on fatal intoxications was performed in the period between 1991 and 1997, when selective serotonin reuptake inhibitors (SSRIs) were establishing themselves on the market, reaching the top of prescription statistics. Tricyclic antidepressants (TCAs) were involved in 30 single- and 127 multiple-substance intoxications, with amitriptyline and doxepin being the most frequently used drugs. SSRIs were involved in five multiple-substance intoxications. The f-value, which refers to the number of deaths per million defined daily doses prescribed, was found to be significantly (P

  1. The spectrum of pathological changes in the lung in children with the acquired immunodeficiency syndrome: an autopsy study of 36 cases.

    PubMed

    Moran, C A; Suster, S; Pavlova, Z; Mullick, F G; Koss, M N

    1994-09-01

    We present the pulmonary findings in 36 autopsies of children affected by the acquired immunodeficiency syndrome (AIDS). Twenty-three patients were male and 13 were female, ranging in age between 3 days and 13 years. Twenty children had human immunodeficiency virus (HIV)-positive parents or parents who were at high risk of exposure (intravenous drug abusers and prostitutes), five had a history of transfusion, and one had a history of renal transplantation and blood transfusion. Clinically, the patients presented with recurrent infections, failure to thrive, hepatosplenomegaly, fever, cough, and/or hemoptysis. Histologically, specific infectious processes were the most common finding (75% of cases), with Pneumocystis carinii pneumonia being the most prevalent type of infection, followed by bacterial pneumonia. Neoplastic conditions and lymphoid interstitial pneumonia were less frequent (approximately 10% of cases). In addition, in approximately 10% of the cases the pulmonary findings were non-specific (ie, pulmonary edema and atelectasis) and probably unrelated to HIV infection. Our findings suggest that specific infectious conditions constitute the most common type of pulmonary pathology in children with AIDS. However, because there is a small percentage of children with nonspecific findings, a transbronchial biopsy is important for proper evaluation before institution of therapy.

  2. Cerebrovascular smooth muscle actin is increased in nondemented subjects with frequent senile plaques at autopsy: implications for the pathogenesis of Alzheimer disease.

    PubMed

    Hulette, Christine M; Ervin, John F; Edmonds, Yvette; Antoine, Samantha; Stewart, Nicolas; Szymanski, Mari H; Hayden, Kathleen M; Pieper, Carl F; Burke, James R; Welsh-Bohmer, Kathleen A

    2009-04-01

    We previously found that vascular smooth muscle actin (SMA) is reduced in the brains of patients with late stage Alzheimer disease (AD) compared with brains of nondemented, neuropathologically normal subjects. To assess the pathogenetic significance and disease specificity of this finding, we studied 3 additional patient groups: nondemented subjects without significant AD type pathology ("Normal"; n = 20), nondemented subjects with frequent senile plaques at autopsy ("Preclinical AD"; n = 20), and subjects with frontotemporal dementia ("FTD"; n = 10). The groups were matched for sex and age with those previously reported; SMA immunohistochemistry and image analysis were performed as previously described. Surprisingly, SMA expression in arachnoid, cerebral cortex, and white matter arterioles was greater in the Preclinical AD group than in the Normal and FTD groups. The plaques were not associated with amyloid angiopathy or other vascular disease in this group. Smooth muscle actin expression in the brains of the Normal group was intermediate between the Preclinical AD and FTD groups. All 3 groups exhibited much greater SMA expression than in our previous report. The presence of frequent plaques and increased arteriolar SMA expression in the brains of nondemented subjects suggest that increased SMA expression might represent a physiological response to neurodegeneration that could prevent or delay overt expression dementia in AD.

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

    PubMed

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

    2015-04-01

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

  4. [Peripartal mortality in an autopsy sample of the Pathologic Institute of the Department of Medicine of the Karl Marx University in Leipzig 1960-1982].

    PubMed

    Emmrich, P; Wötzel, E

    1986-01-01

    Between 1960 and 1982 we have autopsied 88 cases of peripartal mortality in the pathological institute of the department of medicine, Karl-Marx-University of Leipzig. According to the legal instruction in the GDR we have subdivided in direct and indirect peripartal death cases (direct and indirect relation between maternal mortality and pregnancy). We have compared both the groups (1960-1969, 1970-1982) and have found: The number of cases with indirect and direct relation between maternal mortality and pregnancy is decreased markedly in the second time period. The composition within the two time groups is very different in respect to the cause of the mortality: Between 1960 and 1969 amnioticfluid embolism, thromboembolism and air embolism, furthermore preeclampsia and their consequences as well as hemorrhages sub partu and postpartum could be found. In the second time group the most frequent causes of peripartal mortality are the different forms of embolism and preeclampsia, but then cases with a indirect relation between mortality and pregnancy with diseases of the cardiopulmonary system and of the kidneys.

  5. Comparison between the collagen intensity and mast cell density in the lingual muscles and myocardium of autopsied chronic chagasic and nonchagasic patients.

    PubMed

    Roldão, José A; Beghini, Marcela; Ramalho, Luciana S; Porto, Carla Souza; Rodrigues, Denise B R; Teixeira, Vicente P A; de Lima Pereira, Sanívia A

    2012-08-01

    In chronic Chagas' disease (CD), an increase in collagen intensity and mast cell density has been described individually in the myocardium and tongue muscles. The aim of this study was to compare the percentage of collagen, mast cell tryptase (MCT) density, and mast cell chymase (MCH) density in the lingual muscles and myocardium from autopsied chagasic (CP) and nonchagasic patients (NCP). The selected cases were divided into two groups: (1) CP (n = 10) and (2) NCP (n = 10). Fragments were removed from the tongue and heart. After histological processing, the slices were stained with picrosirius, and immunohistochemistry was performed for MCH and MCT. The CP group showed the highest MCH and MCT densities and the highest percentage of collagen in the lingual muscles and myocardium when compared with the NCP group (p < 0.05). A significant positive correlation was observed between the collagen intensity and MCH density in the myocardium of the CP group. Although there are no reports in the literature of MCT and MCH in CD, its higher densities as well as higher percentage of collagen were found in the lingual muscles and myocardium in the CP group, suggesting that tryptase and chymase are associated with the pathogenesis of CD in these organs. Furthermore, the positive and significant correlation between the percentage of collagen and MCH density in the myocardium of the CP group suggests that the chymase is associated with fibrosis in CD, as demonstrated in other diseases.

  6. "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.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. [Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000].

    PubMed

    Remiszewski, P; Langfort, R; Podsiadło, B; Kuś, J; Płodziszewska, M; Radzikowska, E; Roszkowska, B; Szopiński, J; Tomkowski, W; Wawrzyńska, L; Wiatr, E; Wierzbicka, M; Załeska, J; Załeska, M; Zych, J; Rowińska-Zakrzewska, E

    2002-01-01

    The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

  12. Improved discrimination of autopsy-confirmed Alzheimer's disease (AD) from non-AD dementias using CSF P-tau(181P).

    PubMed

    Koopman, Karen; Le Bastard, Nathalie; Martin, Jean-Jacques; Nagels, Guy; De Deyn, Peter P; Engelborghs, Sebastiaan

    2009-09-01

    To establish diagnostic accuracy (acc) and optimal cut-off levels of CSF tau phosphorylated at threonine 181 (P-tau(181P)) for discriminating Alzheimer's disease (AD) from non-AD dementias in autopsy-confirmed dementia patients, CSF levels of beta-amyloid peptide (Abeta(1-42)), total tau protein (T-tau) and P-tau(181P) from patients with definite AD (n=95) and non-AD dementias (n=50) were determined with single-parameter ELISA kits. Optimal P-tau(181P) cut-off levels for differentiating AD from pooled non-AD dementias, dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD) were 50.4pg/mL (acc=0.73), 52.8pg/mL (acc=0.73) and 35.3pg/mL (acc=0.90), respectively. The optimal CSF P-tau(181P) cut-off level for discriminating AD from non-AD dementias was 50.4pg/mL. Optimal CSF P-tau(181P) cut-off levels differed between non-AD diagnostic dementia categories.

  13. The relationship between impulsivity and suicide among rural youths aged 15-35 years: a case-control psychological autopsy study.

    PubMed

    Lin, Lin; Zhang, Jie; Zhou, Li; Jiang, Chao

    2016-01-01

    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.

  14. 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.

  15. 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.

  16. Epstein-Barr virus-positive T-cell lymphoma cells having chromosome 22q11.2 deletion: an autopsy report of DiGeorge syndrome.

    PubMed

    Itoh, Shigemi; Ohno, Tadayuki; Kakizaki, Shuhei; Ichinohasama, Ryo

    2011-12-01

    Reported herein was the first autopsy case of Epstein-Barr virus-associated T-cell lymphoma in a 25-year-old man with DiGeorge syndrome. Systemic lymph nodes demonstrated diffuse encasement by large lymphoma cells positive for CD45, CD2, CD3, CD5, CD7, CD8, TIA1, and granzyme B, accompanied with marked hemophagocytosis. Almost 100% of lymphoma cells were both EBER- and LMP-1-positive, and EBNA2-negative. The rearrangement of T-cell receptor β gene was proved by polymerase chain reaction. Clinical and pathologic features coincided with Epstein-Barr virus-associated T/NK-cell lymphoproliferative disorder preceded by chronic active Epstein-Barr virus infection. A fluorescence in situ hybridization using paraffin-embedded tissues demonstrated a mosaic chromosome 22q11.2 deletion with both host cardiac myocytes and lymphoma cells, suggesting that Epstein-Barr virus-associated T-cell lymphoma was associated with and derived from the cells carrying the chromosomal abnormality. Furthermore, the lymphomagenesis of our case correlated with defect of cellular immunity in DiGeorge syndrome.

  17. Prevalence of thyroiditis and immunohistochemistry study searching for a morphologic consensus in morphology of autoimmune thyroiditis in a 4613 autopsies series.

    PubMed

    Vecchiatti, Stella M P; Lin, Chin Jia; Capelozzi, Vera L; Longatto-Filho, Adhemar; Bisi, Hélio

    2015-07-01

    We sought to verify the prevalence of lymphocytic thyroiditis (LT) and Hashimoto's thyroiditis (HT) in autopsy materials. Cases examined between 2003 and 2007 at the Department of Pathology of Faculty of Medicine of São Paulo University were studied. Immunohistochemical analyses were conducted in selected cases to characterize the type of infiltrating mononuclear cells; in addition, we evaluated the frequency of apoptosis by TUNEL assay technique and caspase-3 immunostaining. Significant increase in overall thyroiditis frequency was observed in the present series when compared with the previous report (2.2978% vs. 0.0392%). Thyroiditis was more prevalent among older people. Selected cases of LT and HT (40 cases each) had their infiltrating lymphocytes characterized by immunohistochemical analyses. Both LT and HT showed similar immunostaining patterns for CD4, CD8, CD68, thus supporting a common pathophysiology mechanism and indicating that LT and HT should be considered different presentations of a same condition, that is, autoimmune thyroiditis. Moreover, apoptosis markers strongly evidenced that apoptosis was present in all studied cases. Our results demonstrated an impressive increase in the prevalence of thyroiditis during recent years and our data support that the terminology of autoimmune thyroiditis should be used to designate both LT and HT. This classification would facilitate comparison of prevalence data from different series and studies.

  18. 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

  19. Synergistic effect of air pollution and habitual smoking on the retention of inorganic fibers identified as ferruginous bodies in autopsy cases in Mexico City.

    PubMed

    Salazar-Flores, Margarita; Rivera-Rodríguez, Rosa María; Vázquez-Manriquez, María Eugenia; Arenas-Huertero, Francisco

    2009-08-01

    In order to evaluate the synergistic effect of habitual smoking and air pollution in Mexico City on the retention of inorganic fibers, ferruginous bodies (FB) were quantified as markers of exposure to inorganic fibers in lung digests from 426 autopsy cases. FB were isolated from 426 lung digests from cases with several lung diseases. The results revealed more retention of FB in the smokers group than in non-smokers: 38 FB per gram (FB/g) versus 11.2 FB/g, respectively (p < 0.05). Male smokers living in Mexico City increased their median to 54 FB/g. This contrasts with the median of outside residents: 11.2 FB/g (p < 0.002). Housewives and manual laborers increased their medians when the smoking habit was positive: from 11 to 14 FB/g, and from 16 to 21.5 FB/g, respectively. There is an effect of tobacco smoke on the retention of more fibers identified as FB when the individuals are males and Mexico City residents.

  20. 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.

  1. Changing patterns of infections in patients with AIDS: a study of 279 autopsies of prison inmates and nonincarcerated patients at a university hospital in eastern Texas, 1984-1993.

    PubMed

    Lyon, R; Haque, A K; Asmuth, D M; Woods, G L

    1996-08-01

    Reports on autopsies of 279 persons infected with human immunodeficiency virus (HIV) were reviewed retrospectively to determine changes in survival rates and infections and to identify differences between prison inmates and nonincarcerated patients. The 78 cases from 1984 through 1988 were compared with 201 from 1989 through 1993, on the basis of use of antiretroviral therapy and (after 1988) prophylaxis against Pneumocystis carinii pneumonia (PCP). Risk factors for HIV infection were homosexuality/bisexuality (30%), injection drug use (IDU; 22%), transfusion (5%), heterosexual contact (4%), and combinations of the above or unknown factors (38%); 95% of patients were males and 41% were state prison inmates in Texas. IDU was more common and homosexuality/ bisexuality was less common among inmates than among nonincarcerated patients. Mean survival time was 12 months in the first period studied and 23 months in the later period (P < .05). Cytomegalovirus infection was the most common type in both periods. The number of cases of PCP declined and the number of cases of bacterial infections increased significantly in the later period. Tuberculosis was significantly more common in inmates than in nonincarcerated patients. Tuberculosis and disseminated histoplasmosis (noted at autopsy) and deaths due to disseminated Mycobacterium avium complex and histoplasmosis were significantly more common among injection drug users than among homosexuals/bisexuals. Invasive candidiasis was more common in homosexuals/ bisexuals and in those who survived > 3 years. Antiretroviral therapy, prophylaxis for PCP, and risk factors for HIV infection appear to influence the mortality rate and prevalence of certain infections found at autopsy.

  2. Autopsy tissues as biological monitors of human exposure to environmental pollutants. A case study: Concentrations of metals and PCDD/Fs in subjects living near a hazardous waste incinerator.

    PubMed

    Domingo, José L; García, Francisco; Nadal, Martí; Schuhmacher, Marta

    2017-04-01

    Human biomonitoring is of tremendous importance to prevent potential adverse effects derived from human exposure to chemicals. Blood and urine are among the biological monitors more frequently used. However, biological matrices such as breast milk, hair, nails, saliva, feces, teeth, and expired air are also often used. In addition, and focused mainly on long-term exposure, adipose tissue and other human tissues like bone, liver, brain or kidney, are also used as biological monitors of certain substances, especially for long-term biomonitoring. However, for this kind of tissues sampling is always a limiting factor. In this paper, we have examined the role of autopsy tissues as biological monitors of human exposure to environmental pollutants. For it, we have used a case study conducted near a hazardous waste incinerator (HWI) in Catalonia (Spain), in which the concentrations of metals and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), have been periodically determined in autopsy tissues of subjects living in the area under potential influence of the facility. This case study does not show advantages -in comparison to other appropriate biomonitors such as blood- in using autopsy tissues in the monitoring of long-term exposure to metals and PCDD/Fs.

  3. 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

  4. Demographic, clinical and pathological features of sudden deaths due to myocarditis: Results from a state-wide population-based autopsy study.

    PubMed

    Li, Liliang; Zhang, Yang; Burke, Allen; Xue, Aimin; Zhao, Ziqin; Fowler, David; Shen, Yiwen; Li, Ling

    2017-03-01

    Causes of sudden cardiac deaths have been widely reported with limited data focused specifically on myocarditis. A retrospective review of cases from the Office of the Chief Medical Examiner (OCME), State of Maryland yielded a total of 103 sudden unexpected deaths (SUDs) due to myocarditis (0.17% of all SUDs and 0.70% of autopsied SUDs) from 2005 through 2014. Most deaths occurred in patients <30 years of age with a male:female ratio 1.3:1. Of the 103 cases, 45 (43.7%) patients were witnessed collapsed. Four deaths occurred during exertion, such as exercising at the gym or performing heavy physical work, and 2 deaths were associated with emotional stress. The common cardiac macroscopic findings included ventricular dilatation (39.8%), mild coronary stenosis (17.5%), mottled myocardial appearance (15.5%), and myocardial fibrosis (10.7%). The histological classification of myocarditis was based on the predominant type of inflammatory cell infiltration. In our study group, lymphocytic myocarditis was most common, accounting for 56 cases (54.4%), followed by neutrophilic (32 cases, 31.7%), eosinophilic (13 cases, 12.6%) and giant cell type (2 cases, 1.9%). Microscopic examination revealed myocyte necrosis in 69 cases (67.0%) and interstitial or perivascular fibrosis in 48 cases (46.6%). The percentage of myocyte necrosis was 75.0% (42/58 cases) in lymphocytic, 65.6% (21/31 cases) in neutrophilic, 30.8% (4/13 cases) in eosinophilic, and 100% (2/2 cases) in giant cell myocarditis. Determination of myocarditis as cause of death continues to present a major challenge to forensic pathologists, because histopathologic findings can be subtle and the diagnosis of myocarditis remains difficult.

  5. 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%).

  6. Homovanillic acid and 5-hydroxyindole acetic acid as biomarkers for dementia with Lewy bodies and coincident Alzheimer’s disease: An autopsy-confirmed study

    PubMed Central

    Takao, Masaki; Hatsuta, Hiroyuki; Nishina, Yasushi; Komiya, Tadashi; Sengoku, Renpei; Nakano, Yuta; Uchino, Akiko; Sumikura, Hiroyuki; Saito, Yuko; Kanemaru, Kazutomi; Murayama, Shigeo

    2017-01-01

    Dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) are the two most common causes of dementia. Both pathologies often coexist, and AD patients with concomitant neocortical LB pathology (referred to as the Lewy body variant of AD) generally show faster cognitive decline and accelerated mortality relative to patients with pure AD. Thus, discriminating among patients with DLB, AD, and coincident DLB and AD is important in clinical practice. We examined levels of homovanillic acid (HVA), 5-hydroxyindole acetic acid (5-HIAA), tau, phosphorylated tau (p-tau), and beta-amyloid (Aβ) 1–42 in cerebrospinal fluid (CSF) to evaluate their viability as biomarkers to discriminate among different forms of dementia. We obtained a total of 3498 CSF samples from patients admitted to our hospital during the period from 1996 to 2015. Of these patients, we were able to carry out a brain autopsy in 94 cases. Finally, 78 neuropathologically diagnosed cases (10 AD, six DLB, five DLB with AD, five controls without neurological diseases, and 52 cases with other neurological diseases) were studied. CSF levels of HVA and 5-HIAA were consistently decreased in pathologically advanced Lewy body disorder (LBD; Braak LB stages >3) compared with pathologically incipient LBD (Braak LB stages <2). These results suggest that if an individual has LB pathology in the central nervous system, CSF levels of HVA and 5-HIAA may decrease after the onset of clinical symptoms. In addition, CSF levels of HVA and 5-HIAA decreased with LB pathology, and were especially low in cases of DLB and DLB with AD. Furthermore, the combination of HVA, 5-HIAA, and brain specific proteins t-tau, p-tau, and Aβ 1–42 in CSF were useful for discriminating among DLB, DLB with AD, and AD with high diagnostic accuracy. PMID:28166276

  7. Entrance and exit wounds of high velocity bullet: An autopsy analysis in the event of dispersing the mass rally in Bangkok Thailand, May 2010.

    PubMed

    Peonim, Vichan; Srisont, Smith; Udnoon, Jitta; Wongwichai, Sompong; Thapon, Arisa; Worasuwannarak, Wisarn

    2016-11-01

    Fatal mass casualties by high velocity bullets (HVBs) are rare events in peaceful countries. This study presents 27 forensic autopsy cases with 32 shots fired by 5.56×45mm. HVB (M-16 rifle bullets) during the dispersing the mass rally in Bangkok Thailand, May 2010. It was found that twenty-three (71.88%) typical entrance HVB wounds had round sizes less than the bullet diameters. Most entrance wounds had microtears but no collar abrasion since a HVB has a small streamlined spitzer tip and full metal jacket. For exit wounds, there were various sizes and shapes depending on which section of wound ballistics presented when the bullet exited the body. If a bullet exited in the section of temporally cavity formation, there would be a large size exit wound in accordance with the degree of bullet yaw. This is different from civilian bullets whereby the shape looks like a cylindrical round nose and at low velocity that causes entrance wounds with a similar size to the bullet diameter and is usually round or oval shape with collar abrasion. The temporary cavity is not as large as in a HVB so exit wounds are not quite as large and present a ragged border compared to a HVB. We also reported 9 out of 32 shots (28.13%) of atypical entrance wounds that had various characteristics depending on site of injury and destabilization of bullets. These findings may be helpful to forensic pathologists and to give physicians, who need to diagnose HVB wounds, more confidence.

  8. 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.

  9. 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

  10. Molecular pathology of brain edema after severe burns in forensic autopsy cases with special regard to the importance of reference gene selection.

    PubMed

    Wang, Qi; Ishikawa, Takaki; Michiue, Tomomi; Zhu, Bao-Li; Guan, Da-Wei; Maeda, Hitoshi

    2013-09-01

    Brain edema is believed to be linked to high mortality incidence after severe burns. The present study investigated the molecular pathology of brain damage and responses involving brain edema in forensic autopsy cases of fire fatality (n = 55) compared with sudden cardiac death (n = 11), mechanical asphyxia (n = 13), and non-brain injury cases (n = 22). Postmortem mRNA and immunohistochemical expressions of aquaporins (AQPs), claudin5 (CLDN5), and matrix metalloproteinases (MMPs) were examined. Prolonged deaths due to severe burns showed an increase in brain water content, but relative mRNA quantification, using different normalization methods, showed inconsistent results: in prolonged deaths due to severe burns, higher expression levels were detected for all markers when three previously validated reference genes, PES1, POLR2A, and IPO8, were used for normalization, higher for AQP1 and MMP9 when GAPDH alone was used for normalization and higher for MMP9, but lower for MMP2 when B2M alone was used for normalization. Additionally, when B2M alone was used for normalization, higher expression of AQP4 was detected in acute fire deaths. Furthermore, the expression stability values of these five reference genes calculated by geNorm demonstrated that B2M was the least stable one, followed by GAPDH. In immunostaining, only AQP1 and MMP9 showed differences among the causes of death: they were evident in most prolonged deaths due to severe burns. These findings suggest that systematic analysis of gene expressions using real-time PCR might be a useful procedure in forensic death investigation, and validation of reference genes is crucial.

  11. Concentrations of alprazolam in blood from impaired drivers and forensic autopsies were not much different but showed