Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “AUTOPSIES”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed1977

[The significance of the clinical autopsy from the viewpoint of the pathologist].

Selected examples are cited to show that, even today, autopsy can provide the clinician with essential information. The most important task of clinical autopsy is analysis of the individual case and correlation between clinical and autopsy findings. The discrepancies that may arise here are illustrated by cases of endocarditis. Spontaneous or therapeutic alterations of disease forms can only be established by autopsy, as is exemplified by indigenous systemic mycoses. The part autopsy can play in the analysis of new disease entities is illustrated in the case of analgesic nephropathy. From this it emerges that autopsy serves not only to establich terminal states but also the early stages. The example of malignant tumors which eluded clinical diagnosis is cited to demonstrate the value of autopsy statistics. In conclusion, an appeal is made for more intensive cooperation between clinician and pathologist and wider use of modern methods in the evaluation of autopsies.

Aspergillosis↗
PubMed1996

The autopsy. Simple thoughts about the public needs and how to address them.

Dialogue regarding the autopsy has been sustained largely by medical students and professionals, and by families of deceased patients. Exclusion of the general public may represent a significant reason for the inexorable decline of autopsy rates and politicoeconomic support. Sensitivity to public concerns regarding the autopsy process carries far-reaching moral and educational significance. A better understanding of the social value of the autopsy will help to ensure its survival in a climate of ever-tightening health-care budgets. Emphasis must be placed on integrating the autopsy process, from the initial request, performance and post-autopsy follow-up with families, to the diagnostic, pathobiologic and epidemiologic interpretation of the results obtained. Opportunities for investigating cause of death currently lie primarily in animal models or in forensic postmortem material where the cause of death is frequently known. Public awareness of the autopsy's special role in the setting of natural and unexplained death is essential if the autopsy is to be retained as a key tool in understanding human disease.

Autopsy↗
PubMed1998

Forensic autopsy in a pathology training program.

OBJECTIVE: To review a satellite facility's autopsy experience with coroner's cases, to determine the volume and type of cases performed; and to evaluate the teaching value of forensic autopsies in a pathology residency training program. DESIGN: A retrospective review of 65 Los Angeles County Coroner cases performed at Cedars-Sinai Medical Center, Los Angeles, Calif, from 1992 to 1996 was undertaken. Data were retrieved from cause of death statements, medical report forms, and autopsy reports. RESULTS: In the 65 coroner's cases performed from 1992 to 1996, ages ranged from 6 months to 97 years. During this time period, the cases comprised 6.1% (65/1059) of all autopsies at Cedars-Sinai Medical Center and 11.3% (65/575) of autopsies excluding fetal and neonatal examinations. Manners of death in the cases were accidental (53.8%), natural (40.0%), suicide (4.6%), and undetermined (1.5%). The most common cause of death in natural deaths was related to heart disease (12/26 [46.2%]). Motor vehicle collisions were the most common cause of death (15/35 [42.9%]) in the accidental group. The remainder of the causes of death in both the natural and accidental groups encompassed a wide variety of pathologic processes and injuries. CONCLUSIONS: Forensic autopsies in a pathology residency training program have the potential to supplement a diminishing number of hospital autopsies. A wide variety of diseases are encountered through coroner's cases. Forensic autopsies contribute to residency training by providing experience in trauma cases and a variety of medical disorders.

Adolescent↗
PubMed2005

Neuropathology of human immunodeficiency virus infection: a forensic autopsy study in Dar Es Salaam, Tanzania.

The objective of this study was to examine the neuropathological changes in the brain of patients infected with human immunodeficiency virus (HIV) in the Tanzanian capital Dar Es Salaam, and investigate whether the prevalence of different forms of HIV-related neuropathology varies from other countries. The subjects were patients with risk factors for HIV infection in whom forensic autopsies were performed between 1997 and 1999. In Dar Es Salaam, forensic autopsy constitutes more than 90% of all autopsies, because hospital autopsy is limited due to socio-cultural and religious reasons. HIV infection was identified in 52 of 143 patients selected from forensic autopsies. Neuropathological findings were observed in 31 of 52 HIV-infected patients; these include lymphocytic meningitis 19, bacterial meningitis 3, tuberculous brain abscess 3, cryptococcal meningitis 3, basal ganglia calcification 3, and toxoplasma encephalitis 1. HIV encephalitis, lymphoma, and cytomegalovirus encephalitis could not be found in this study. Whereas the findings should be interpreted cautiously because of possible autopsy bias and a low percentage of cases examined compared to the total number of HIV-infected patients in Tanzania, our observations provide information on the likely diagnostic possibilities to be considered in the evaluation and management of HIV-infected patients with neurological symptoms in Tanzania. In the face of decreased hospital autopsy, most studies have focused mainly on the end-stage HIV disease; forensic autopsy is a potential source of materials for studies on HIV disease spectrum at different stages.

Adolescent↗
PubMed1987

Parental and physician-related determinants of consent for neonatal autopsy.

We undertook a cross-sectional epidemiologic study of potential determinants of parental consent for neonatal autopsy at the Brigham and Women's Hospital, Boston. Data were abstracted from maternal and infant medical records in 184 cases of neonatal death occurring between January 1982 and October 1984. The overall consent rate for neonatal autopsy was 72%. Multivariate analysis by logistic regression found previous fetal loss, gestational age, and cause of death to be significantly different between the groups of consenters and nonconsenters. Parents least likely to consent to autopsy were those who had no history of previous fetal loss, who had pregnancies in which the birth weight of the infant was less than 1000 g or the gestational age was less than 28 weeks, or those who had an infant die of extreme prematurity. Factors not significantly associated with consent were maternal age, race, marital status, transfer status, type of prenatal care, the infant's sex, and the staff position of the requester. A second phase of the study surveyed physicians' attitudes regarding the importance of neonatal autopsy. The staff position and previous experience of the physician-requester, in addition to the presumed cause of the infant's death, were significantly associated with the rating assigned to the importance of the autopsy. These findings suggest that the mother's past and present obstetrical experience, the presence of extreme prematurity, and possibly the attitude and experience of the physician requesting autopsy permission may exert important influences on the likelihood of obtaining consent for a neonatal autopsy.

Adult↗
PubMed1995

Laparoscopic vs conventional autopsy. A promising perspective.

OBJECTIVE: To analyze the sensitivity and specificity of laparoscopic autopsy when compared with the ulterior performance of conventional postmortem examination. DESIGN: Consecutive sampling, case-series study. SETTING: A general community referral medical center and the local institute of forensic medicine. PARTICIPANTS: A consecutive sample of 25 fresh cadavers (< 24 hours old) of victims of vehicle accidents, gunshot wounds, and in-hospital deaths. INTERVENTIONS: After insufflation with carbon dioxide, laparoscopy of the abdominal cavity and inspection of the retroperitoneal area was accomplished. Following, a conventional postmortem examination was performed and the findings of both procedures were recorded, compared, and analyzed. MAIN OUTCOME MEASURES: Prior to the beginning of the study, it was hypothesized that laparoscopic autopsy would reach an overall sensitivity and specificity of at least 85% and enable accurate inspection of the abdominal cavity and retroperitoneum in the search for the trauma-related cause of death in trauma victims or the cause of death for in-hospital patients. RESULTS: There was a 100% correlation of both procedures in all accidental cases. The sensitivity of laparoscopic autopsy was 93% for intra-abdominal lesions, with an overall sensitivity of 91%. For the retroperitoneal area, the sensitivity was 58%. The sensitivity for the retroperitoneum dropped, owing to an intrarenal tumor and an extraperitoneal rectal tear in the small sample of inhospital deaths. The specificity of laparoscopic autopsy reached 94%. CONCLUSIONS: Laparoscopic autopsy is accurate and easy to perform. It is highly sensitive for intra-abdominal abnormalities, especially in trauma victims. Laparoscopic autopsy is minimally invasive and not disfiguring, rendering it easier to accept among mourning families. It should be strongly considered when consent for a conventional autopsy is lacking.

Autopsy↗
PubMed1988

Autopsy findings in AIDS-related lymphoma.

Autopsies in 20 patients with the acquired immune deficiency syndrome (AIDS)-related lymphoma were studied retrospectively to ascertain the precise cause of death and the extent of lymphomatous disease. Eight patients had primary central nervous system (CNS) lymphoma: two of them were diagnosed antemortem; CNS lymphoma was suspected in three others by computerized tomographic (CT) scan and was confirmed at autopsy. The remaining three were diagnosed incidentally at autopsy. All had concurrent infections at autopsy, including opportunistic infection in six and pyogenic infections in two. Opportunistic infections at autopsy in these patients outnumbered those diagnosed clinically. Twelve patients had systemic lymphoma. Three were diagnosed only at autopsy, two of whom had extensive Kaposi's sarcoma (KS) as well. Eight patients were treated with chemotherapy, but died with disseminated disease. Opportunistic infections were found at autopsy in five patients. Secondary involvement of the CNS by lymphoma was frequent (66%) and was not related to previous bone marrow involvement. The authors conclude that the incidence of lymphoma occurring in AIDS may be more frequent than diagnosed clinically. Similarly, multiple opportunistic infections occur in these patients which are not diagnosed premortem and may contribute to early death.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Accuracy of death certificates: a population-based, complete-coverage, one-year autopsy study in East Germany.

The Goerlitz Autopsy Study is a population-based autopsy study, conducted in 1987 in the municipality of Goerlitz, population 78,484, in former East Germany. It is unique in that 1,023 (96.5 percent) of the 1,060 subjects who died in the municipality over a period of one year were investigated by full autopsy. An underlying cause was assigned to every death, using the procedures recommended by the International Classification of Diseases, Injuries and Causes of Death, ninth revision, German edition. Assignment of cause of death was done independently by the attending clinician and the pathology team who performed the autopsy. The data were analyzed through cross-classification of deaths by death certificate diagnosis and autopsy-based diagnosis. Sensitivity and positive predictive values were calculated for the death certificate diagnoses, assuming that the autopsy findings represent the correct reference set. Overall, 47 percent of diagnoses on death certificates differed from those based on autopsy and, for 30 percent of the subjects, the difference crossed a major disease category. The proportion of disagreement was higher for deaths occurring in nursing homes and among the very old, but was unrelated to gender. In the death certificates, diseases of the circulatory system and endocrine and metabolic disorders were over-represented, whereas infectious diseases, neoplasms, and respiratory, digestive, and genitourinary diseases were under-represented. Neoplasms in the death certificates are characterized by relatively high sensitivity and predictive values, even though these were still unsatisfactory, given the chronicity of the clinical course and the opportunities available for correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Autopsy rate in younger and older hospitalized patients.

A retrospective study of the autopsy rate of the clinico-pathological correlations was made in a group of inpatients. The trend of autopsy rate was observed in all inpatients died in a university hospital during a nine year period (from 1975 to 1983). The agreement between the clinical and pathological death diagnosis was retrospectively controlled in 294 consecutive patients died and submitted to autopsy in the same hospital during a 6 month period (from January to June 1983). The results show that: In the oldest (greater than 60 yrs) patients, the autopsy rate trend was significantly reduced from 1975 to 1983, whereas the hospital admissions and the mortality rate increased. In the youngest subjects (less than 60 yrs), the autopsy rate trend, the hospital admissions and the mortality rate did not significantly change from 1975 to 1983. In all the years considered, the autopsy rate was significantly reduced in the oldest class (p less than 0.001). The agreement between the clinical and pathological diagnosis was observed in 83% of cases in the less than 60 years class and in 63% of cases in the greater than 60 yrs class (p less than 0.001). The association of main disease with other diseases was significantly more frequent in the greater than 60 yrs class with respect to the less than 60 yrs class (p less than 0.01). It has been concluded that the autopsy, especially in the elderly, is absolutely necessary for a better quality control of the clinical diagnosis and of the medical care.

Age Factors↗
PubMed1976

Malignant disease of infancy and childhood with special reference to leukaemia: a survey of 6431 autopsy cases.

A study on the prevalence of cancer at autopsy in Chilean children with special reference to leukaemia, was made. In a series of 15300 consecutive autopsies of Chileans, 70% of deceased patients had an autopsy. Of these 15300 cases (male:female ratio 1:0.92) 6431 were children (0-15 years of age); 90% of deceased children patients had an autopsy. The autopsy population of children and adults is a homogeneous ethnic group, and exhibits a low socioeconomic level. Data on the 6431 post-mortem examinations (1945-1966) came from the atuopsy records of five hospitals (four of them are teaching hospitals) in the city of Santiago. Each one of the leukaemia and solid tumour cases were diagnosed microscopically. In the children population, 54.92% were males and 45.08% were females. Of the 6431 autopsies, 142 exhibited cancer (2.21%), 2.43% being male cases and 1.93% being female cases. The autopsy cases showed a marked excess of boys (73.92%) and girls (69.77%) under 1 year of age. The prevalence of major morphological groups of cancer was as follows: leukaemias 50.70%, intracranial and other neural neoplasms 25.35%, malignant lymphomas, including Hodgkin's disease, 14.07%, and mixed malignant tumours (Wilms' tumour) 4.93%. 4.93%. Acute leukaemias (42.96%), medulloblastoma (7.65%), Hodgkin's disease (6.34%), Wilms' tumour (4.93%), and lymphosarcoma (4.93%) were the most prevalent types of cancer. Leukaemia cases had a corrected male:female ratio of 1:0.61. The prevalence of leukaemia in the atuopsy population was 1.12%.

Age Factors↗
PubMedDate not supplied

Attitudes of house officers toward the autopsy.

STUDY OBJECTIVE: To assess the attitudes of house officers in internal medicine and pathology about the value and use of the autopsy. DESIGN: Self-administered multiple-choice questionnaire. SETTING: Two New York City urban teaching hospitals. SUBJECTS: 112 internal medicine and 37 pathology house officers who were on site during the survey period. MAIN RESULTS: Most internal medicine house officers (86%) felt that the autopsy rate was too low and needed to be increased. The most common reason the residents cited for the low rate was the reluctance of families to grant permission. A majority of medicine housestaff (78%) felt they needed more instruction on how to ask for an autopsy, and 34% had never received feedback from the pathology department on autopsy results. Most pathology residents (94%) felt the autopsy rate was too low; the most common reasons they cited for the low rate were reluctance of clinicians to request permission and clinicians' fears of being sued for malpractice. CONCLUSIONS: House officers in internal medicine and pathology agreed that autopsies should be performed more frequently, and identified problems in obtaining autopsies that should be addressed by educational, organizational, and regulatory strategies.

Attitude of Health Personnel↗
PubMed1985

Autopsy: moribund art or vital science?

The autopsy rate in the United States has fallen dramatically in the past 40 years. Factors contributing to its decline include diagnostic over-confidence among clinicians, competing demands upon pathologists, difficulties obtaining consent from families, and its costs. The benefits of autopsy are clear: confirmation, clarification, and correction of antemortem diagnoses; discovery and definition of new diseases; evaluation of new diagnostic tests, new surgical techniques, and new drugs; investigation of environmental and occupational diseases; reassurance of family members; and contributions to medical and epidemiologic research. Proposals to revive the autopsy are reviewed, including altering the method of obtaining consent, altering autopsy procedures, structuring teaching around the autopsy, training autopsy pathologists in anatomic subspecialties, reinstating minimal autopsy requirements for hospital accreditation, providing financial support, and educating the public and the medical profession about its values. Accomplishing these changes quickly will prevent loss of its many benefits to the clinician, family, hospital, and society.

Autopsy↗
PubMed1993

Autopsy findings and clinical diagnoses: a review of 1,000 cases.

The protocols of 1,000 consecutive adult patients autopsied during the period June 1983 to December 1988 were retrospectively analyzed and the findings were compared with clinical diagnoses. The autopsy rates during this period ranged between 23% and 27% of hospital deaths. Eighty-seven percent of the autopsied patients were between 15 and 59 years of age. Major discrepancies between the autopsy reports and the clinical diagnoses were present in 31.7% of all autopsy reports reviewed. Infectious diseases were the most common cause of death (46.8%), followed by cardiovascular diseases (17.1%) and neoplastic diseases (14.3%). Infections were clinically recognized in 66.7% of cases and were missed or found to be incorrect in 33.3% of cases. Tuberculosis comprised 33.8% of the major bacterial infections and was clinically diagnosed in 82% of cases. Eighty-nine percent of the major fungal infections were not suspected clinically. Rheumatic heart disease (43.8%) was the most common cardiovascular disorder and was clinically diagnosed in 93.3% of cases. Pulmonary vascular episodes were the least common cause of death and were not suspected clinically in 62.9% of cases. Malignancies were incorrectly diagnosed in 25.8% of cases. We conclude from this study that routine autopsies revealed major unexpected findings that are of clinical importance, and that a continued emphasis on autopsy evaluation is necessary for the improvement of the quality of patient care.

Adolescent↗
PubMedDate not supplied

The epidemiology of autopsies in cardiovascular deaths of middle-aged men in Finland in 1973.

There were 414 certified deaths from cardiovascular diseases (CVD) in men aged 35--44, and 1372 at ages 45--54, in Finland during 1973. A detailed analysis of the examination of the cause of death in these cases was made by paying specific attention to the autopsy epidemiology. In men aged 35--44 years 68.6% of all cardiovascular deaths and 55.2% at ages 45--54 was verified by autopsy. The autopsy rate of cardiovascular deaths in these two populations of deceased males (1) was in 1973 about three times higher than it had been 10 years earlier, (2) decreased significantly with the age of the deceased population, (3) was higher in urban than in rural areas, (4) was markedly higher in Helsinki than anywhere else in Finland (at ages 35--44 the rate in Helsinki was 94.9% and at 45--54 76.2% in 1973), (5) was dependent on the actual place of death, (6) was higher than the mean rate recorded for all natural deaths in these two groups of male deceased, (7) was higher in the category of cerebrovascular deaths and lower in deaths from ischaemic heart diseases than the mean rate recorded for all cardiovascular deaths, and (8) was composed mainly of medicolegal autopsies, when the cause of death was some ischaemic or functional heart disease; mostly a clinical autopsy was made when the death was due to some other category of CVD. In addition, 76% of the deceased 35--54-year-old males who died from CVD were either autopsied and/or treated in a hospital before death. This result and the quite high national autopsy rates among the deceased young and middle-aged populations give support to the reliability of the national mortality statistics at these ages.

Adult↗
PubMed2005

[Pediatric autopsy and informed parental consent].

AIM: In French legal terminology, the definition of autopsy is "organs'withholding". This phrase is ambiguous, meaning both removing the organs for their macroscopic exam and their retention for subsequent histology. The autopsy of a child requires an informed consent from both parents. The issue is that the pathologist who performs the autopsy is not the one who delivers the information and gets the parents' consent: therefore, he does not know what they were told and what they actually agreed upon. MATERIALS AND METHODS: A questionnaire was sent to 3 groups of paediatricians (N=891) to approach their knowledge regarding autopsy. RESULTS: Among 362 paediatricians who answered the questionnaire, 57.2% never attended an autopsy and procedures were badly known. They did not know whether or not organs, were systematically sampled especially brain. Regarding the possibility of conservation of organs, a majority thought that one should not solely answer to parents'queries (63.8%) but rather that one should point out every possibility, without giving the ins and outs (60.8%). The majority favoured organs retention and use for research. CONCLUSION: We make 3 suggestions: to register autopsy in the Natioanal Securite Sociale nomenclature, to establish information and consent forms for organs'removal, retention and disposal, and to offer parents the possibility of an interview with the pathologist before and/or after the autopsy, in association with the paediatrician.

Autopsy↗
PubMed2006

The value of the metabolic autopsy in the pediatric hospital setting.

OBJECTIVE: To determine the utility of the metabolic autopsy in the hospitalized pediatric patient. STUDY DESIGN: This was a retrospective review of all metabolic autopsies performed at a large pediatric hospital over a 5-year period. Premortem clinical diagnoses were correlated with autopsy findings and results of postmortem testing. RESULTS: Of the 23 metabolic autopsies performed, a metabolic disorder was diagnosed before death in 4 and after death by extensive studies initiated before death in 2. In the remaining 17 cases, postmortem samples were inadequate for subsequent enzymatic analysis in 2, a nonmetabolic explanation for symptoms was identified in 4, and no unifying diagnosis could be defined in 8. A metabolic disorder was diagnosed by postmortem tissue study in 3 of the 17 cases; in all 3 of these cases the patient died in the neonatal period after limited premortem investigation for primary lactic acidosis. For the 8 subjects who had undergone an extensive laboratory workup before death, in each case metabolic autopsy failed to establish a diagnosis. CONCLUSIONS: In a small but significant percentage of cases (18%), the metabolic autopsy successfully identified an undiagnosed metabolic disease. However, metabolic autopsy following an extensive nondiagnostic clinical workup is unlikely to yield a specific metabolic diagnosis.

Autopsy↗
PubMed1990

Use of autopsy results in the emergency department quality assurance plan.

Traditionally, the autopsy is viewed as the ultimate quality assurance indicator in clinical medicine, yet very few clinical departments actually incorporate autopsy results in their formal quality assurance plans. Consequently, to investigate how autopsy results can be included on our emergency department plan, the clinical and autopsy diagnoses of 244 patients were reviewed retrospectively and compared to identify conditions that were unapparent or misdiagnosed at the time of death. The study period was from January 1984 through June 1988. The average yearly ED census was 33,266. Differences between clinical and autopsy diagnoses were categorized as class 1, 2, 3, or 4 findings. Major unexpected findings (classes 1 and 2) were found in ten patients (4%); the most common missed diagnoses were aortic dissection 3 (1.2%) and pulmonary embolus 2 (0.8%). Minor unexpected findings (classes 3 and 4) were discovered in 14 patients (5.8%). The results clearly identify unexpected findings and point to the need for more aggressive evaluations of certain conditions. Systematic review of autopsy data as presented has led to meaningful changes and delivery of care to emergency patients. Autopsies are a vital source of outcome-based information that should be part of every ED's quality assurance and risk management plan.

Autopsy↗
PubMed1983

The value of the autopsy in three medical eras.

To determine whether advances in diagnostic procedures have reduced the value of autopsies, we analyzed 100 randomly selected autopsies from each of the academic years 1960, 1970, and 1980 at one university teaching hospital. In all three eras about 10 per cent of the autopsies revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival; another 12 per cent showed a clinically missed major diagnosis for which treatment would not have been changed. Among 1980 autopsies, renal disease and pulmonary embolus were less common causes of death than before, but systemic bacterial, viral, and fungal infections increased significantly and were missed clinically 24 per cent of the time. The introduction of radionuclide scans, ultrasound, and computerized tomography as diagnostic procedures did not reduce the use of conventional tests in patients who subsequently died and were studied by autopsy. Over-reliance on these new procedures occasionally contributed directly to missed major diagnoses. We conclude that advances in diagnostic technology have not reduced the value of the autopsy, and that a goal-directed autopsy remains a vital component in the assurance of good medical care.

Autopsy↗