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PubMed2005

The autopsy in a tertiary teaching hospital in Brazil.

A high autopsy rate allows accurate epidemiological studies and quality control of medical care. This study aims to analyze all autopsies performed in a university teaching hospital in Brazil during 52 consecutive wk. The following data were retrieved from individual autopsy records: gender, age, time of death (hr, day, and month), and the main cause of death. There were 1419 autopsies (79% adults and 21% pediatrics, 60% male and 40% female). Those performed during working days summed up to 67.5%, the remaining 32.5% were performed during weekends or holidays. Autopsies were more frequent during the nocturnal than diurnal period (52.6% vs 47.4%, respectively). The causes of death distributed among the ICD-10 categories were: cardiovascular diseases 21.3%, infectious diseases 19.2%, neoplasms 12.8%, perinatal conditions 10.8%, respiratory diseases 6.6%, gastrointestinal diseases 6.0%, congenital anomalies 4.7%, CNS diseases 3.8%, genitourinary diseases 1.8%, and others 13.0%. There was coexistence of the diseases typical of both industrialized and developing countries, indicating the epidemiological transition in our country. Our data indicate that staff supervision of undergraduate medical students and residents is adequate. Along with a brief discussion of the historical, cultural, and legal factors that allow a high autopsy rate, this study reinforces the importance of the autopsy in a tertiary teaching hospital.

Adolescent↗
PubMedDate not supplied

[Descriptive epidemiology from autopsies at the Ospedale Maggiore di Milano from 1986 to 1987].

Descriptive epidemiology of autopsies performed at Ospedale Maggiore in Milan 1986-87. With the aim of setting up an autopsy database we have processed and stored data relating to diagnoses from autopsies performed over the two-year period 1986-1987 at Ospedale Maggiore in Milan. We used a program developed on the basis of indications provided by a group of pathologists working in various centres in Italy. The program is designed to include the storage of personal details, clinical diagnoses, autopsy diagnoses, and a semi-automatic procedure for apposition of SNOMED codes. Using this stored material, statistical studies have been carried out on the sample of autopsy subjects and the incidence of the various types of pathology; also, a comparative evaluation has been made between the clinical diagnoses of the cause of death and those derived from autopsy. It appears that clinicians tend to overdiagnose neoplastic diseases and underestimate the significance of cardiocirculatory pathologies. Our data confirm that in spite of the advances in diagnostic technology, autopsy maintains its value and importance as a diagnostic tool, especially for its quality-control role in the public health field; moreover it can also play a significant part in epidemiological studies.

Adolescent↗
PubMed1989

[Evaluation of cancer treatment by autopsy].

Various indices such as tumor markers, X-ray figures and variation of leucocyte count and body weight, are used for objective evaluation of cancer treatment in clinical medicine. On the other hand, autopsy does not provide exact evaluations in this sense. However, our analysis of 105 cancer autopsy cases revealed that autopsy helped to resolve 94.9% of the problems raised in clinical medicine: 94.9% having regard to primary and metastatic tumors, 45.7% with complicating diseases and cause of death 13.3% with appropriateness of diagnosis, and another 13.3% with suitability of treatment. To recover the position of autopsy in medicine, it is important to restore "science" in pathology by incorporating modern scientific methods and by logical analyses of exact findings obtained at autopsy. For this purpose, autopsy findings must be categorised and coded rather than descriptive. On the other hand, it is important to satisfy the clinical side by responding to the needs of rapidly advancing clinical medicine. For this purpose, especially in Japan where there is a shortage of pathologists in medical schools and hospitals, it is essential to involve clinical staffs, postgraduate students, and clinical residents in analysis of autopsy cases.

Autopsy↗
PubMed1989

[The yield of autopsies in a pediatric practice].

The yield of autopsies in a paediatric population. A retrospective analysis is presented of 91 autopsies on children, who died during the period January 1975 and December 1984 in St. Joseph Ziekenhuis, Eindhoven. In 21% of the cases (newborns 23% and older children 13%) the autopsy provided the definitive explanation for the cause of death. In 43% of the cases unexpected findings were obtained during autopsy. In 12% of the cases autopsy could not substantiate a suspected diagnosis and in 12% of the cases the findings at the autopsy influenced genetic counseling. This high rate of return stresses the importance of autopsy as a mean to improve the quality of medical care in a paediatric population.

Autopsy↗
PubMed1989

The current status of the autopsy in academic medical centers in the United States.

As viewed by pathology chairmen, the primary reasons for the decline in interest in the autopsy are: (1) a feeling among physicians that everything is known about the case; (2) poor education of medical students and clinical house staff concerning the importance of the autopsy, which carries over to the practitioner; and (3) lack of interest on the part of pathologists. Negative attitudes on the part of clinicians were seen as the primary factor that serves to inhibit enthusiasm for the autopsy on the part of pathology house staff. Lack of prompt and appropriate communication with the attending physician and uneven quality of prosectors are seen as major inhibitors to successful autopsy services. Chairmen of departments of pathology support an approximate doubling of the autopsy rate in their institutions (from 30% to 64%), although 42.5% of chairmen had not discussed their wishes concerning autopsy with the next of kin and only 42% regularly attend gross conference. These perceptions are remarkably similar to those provided by chairmen of departments of medicine and surgery as a part of a previous survey. On the basis of these inputs, several recommendations designed to improve the local emphasis on the autopsy service are provided.

Academic Medical Centers↗
PubMed1988

Autopsy patterns in patients dying of acquired immunodeficiency syndrome in New York City.

The autopsy rate was examined for patients dying of acquired immunodeficiency syndrome (AIDS) in New York City from 1982 through 1986 to determine if individuals dying of AIDS had autopsy rates that differed from the general population. Using data from death certificates, verified by hospital records, autopsy rates for various diseases and causes of death were examined in persons aged 25 to 44 years, which represents the age group with the majority of AIDS deaths. The hospital autopsy rate for those patients dying of AIDS dropped from 46% in 1982 to 17% in 1986, while the rate for non-AIDS autopsies went from 23% in 1982 to 15% in 1986. These declines have occurred despite the continued presence of a major epidemic in which the pathophysiology is still under active investigation. The low autopsy rate for patients with AIDS is of concern to both epidemiologists and clinical researchers: the autopsy is vital to a better understanding of the spectrum of human immunodeficiency virus infection.

Acquired Immunodeficiency Syndrome↗
PubMed1980

To answer questions. A review of an autopsy service.

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

Autopsy↗
PubMed1981

The frozen-section autopsy.

A protocol for the rapid completion of autopsies using frozen sections was studied. The protocol was tested on 50 autopsy subjects, and the results compared with those from the standard autopsy protocol used on the same 50 cases. Cost, speed with which the reports could be completed, teaching value, and accuracy were compared; autopsy completed by frozen sections was superior in all four areas. There were 47 errors, none of which involved major disease processes. All but nine were errors of sampling and could be remedied by the more liberal sampling of tissues and the occasional supplementation with paraffin sections. The frozen-section autopsy protocol can replace the standard autopsy protocol in most cases. The rapid completion of the autopsy invites participation of the clinician and stimulates cooperation that benefits both the clinician and the pathologist.

Autopsy↗
PubMed1981

Myocardial infarction. How representative are autopsied subjects with this clinical entity?

We documented the differences in clinical features between 86 autopsied and 54 nonautopsied subjects who died of myocardial infarction to ascertain any bias that might be present in use of postmortem data. More than 200 historical, clinical, noninvasive, and hemodynamic aspects were compared. Of noninvasive aspects examined in all subjects, only 13 had significant differences (by chi 2 or unpaired t tests) between autopsied and nonautopsied subjects. However, there had been greater impairment of vital signs and hemodynamic aspects during early hospitalization in the autopsied vs the nonautopsied subjects. Further, the one-month survival rate was lower in autopsied subjects (31% vs 72%; P less than .01). We conclude that patients in severe congestive heart failure or shock and, presumably, with relatively large or complicated myocardial infarcts are more likely to die early and be autopsied. Those with better cardiac function live longer, and often die after having been released from the initial hospitalization; these subjects, presumably with smaller and uncomplicated infarcts, do not undergo autopsy. Before correlating pathological and clinical data from subjects with acute myocardial infarction, it is important to carefully analyze bias inherent in the selection of subjects to undergo autopsy.

Arrhythmias, Cardiac↗
PubMed1994

Comparison of autopsy, clinical and death certificate diagnosis with particular reference to lung cancer. A review of the published data.

Some clinicians and some epidemiologists appear to be under the illusion that techniques available for the diagnosis of internal diseases such as lung cancer have improved so much that autopsies are not necessary on the bodies of most people who die. Partly for this reason, partly for economic reasons and partly because clinicians fear litigation if autopsy shows that they treated patients for the wrong disease, autopsy rates have been falling in most developed countries. The object of the present review was to ascertain how much reliance can reasonably be put on clinical diagnoses made and death certificates completed in the absence of autopsy data. In the case of lung cancer, high rates of false positive and false negative diagnoses are universally prevalent, with biases influencing these rates, so that smokers are more likely to be appropriately investigated for lung cancer, and false negatives are commoner in non-smokers. All investigators who have compared clinical-based and autopsy-based death certificates have concluded that higher autopsy rates are necessary and the results of one study suggest that a high autopsy rate in a hospital leads to improvements in the accuracy of clinical diagnoses. The extent to which diagnoses on death certificates that are dependent solely on clinical data are seriously inaccurate for internal diseases such as lung cancer should engender caution in all who use mortality data to guide public health policies and to identify and quantify environmental risks to healths.

Autopsy↗
PubMed1993

[Attitude of the public to autopsy. A questionnaire study].

A high autopsy rate is a requirement for confirming or correcting clinical diagnoses and for providing opportunities for medical education on pre- and postgraduate level. A telephone survey was conducted to obtain information about the opinion of the Norwegian public on this matter. A randomised sample of 1,050 persons over 15 years of age were asked whether they would consent to autopsy if a close family member died in a hospital. Of the 954 (91%) who agreed to answer, 86% (95% CI 84-89) would consent, while 14% (95% CI 11-16) were unsure or would object. Demographical background variables did not significantly influence the response. When asked if they would give prior consent to an autopsy on themselves, should they die in a hospital, 84% (95% CI 82-87) said they would agree, while 16% (95% CI 13-18) were unsure or would object. Age between 31-50 years, male sex and married civil status significantly increased the likelihood of a positive attitude towards autopsy. The survey revealed a generally favourable attitude in the population towards autopsy. This positive confidence has to be maintained through careful talks with relatives about autopsy, and arrangements for relatives to be informed of the result of an autopsy.

Adolescent↗
PubMed1994

A comparison of public attitudes toward autopsy, organ donation, and anatomic dissection. A Swedish survey.

OBJECTIVE: To evaluate people's reactions to procedures involving the dead body by comparing their attitudes toward autopsy, organ donation, and dissection. DESIGN: Survey, using a questionnaire with 24 items that address reactions toward autopsy, organ donation, and donation of the whole body, including religious and sociodemographic issues. PARTICIPANTS: An age-stratified, random sample of 1950 individuals in Sweden, 18 to 75 years old. The response rate was 65%. RESULTS: Eighty-four percent reported acceptance of an autopsy for themselves and 80% for a close relative. Sixty-two percent were willing to donate their own organs and 39% to donate the organs of a family member; 15% accepted donation of their whole body for dissection. Practically all who accepted dissection also were willing to donate their organs and to be autopsied; practically all who were willing to donate their organs also accepted autopsy. About 65% to 70% felt some discomfort at the thought of autopsy and organ donation. Women seemed more sensitive toward operations on the dead body than men. CONCLUSIONS: The rank order of medical procedures after death, based on the proportion of individuals positive toward the procedures, can be used to form a scale with autopsy and dissection at each end point and organ donation in the middle. This scale has the characteristics of a Guttman scale and can be looked on as a comfort-discomfort continuum regarding procedures involving the dead body.

Adolescent↗
PubMed1993

Medical certification of causes of death in an Australian metropolitan hospital. Comparison with autopsy findings and a critical review.

OBJECTIVES: To compare the causes of deaths recorded on death certificates with findings at autopsy and to identify other deficiencies in the completion of death certificates. DESIGN AND SETTING: The causes of death (Part I and II) recorded on the death certificates of all patients undergoing autopsy at St Vincent's Hospital, Melbourne, in 1992 were compared with the autopsy findings. Additional clinical information about previous medical and surgical history and antemortem investigations was obtained from the clinical summary in the autopsy reports, and from hospital charts in some cases. PATIENTS: In 1992, 132 hospital autopsies were performed (autopsy rate of 24.2%). Of these patients, 68% were aged 65 years or over, and 30% were aged 75 years or over. RESULTS: Major discrepancies between the cause of death listed on the certificates and autopsy findings were found in 16 cases (12%). Other deficiencies of death certification included listing the mode of death (e.g., cardiac failure) without an underlying cause in 14 cases (11%); failure to cite recent major surgery in 17 of 20 cases (85%); failure to specify site or organism in 33 of 40 cases (82.5%) of infection or sepsis. CONCLUSIONS: This study confirmed findings of previous studies with respect to missed major diagnoses, but identified other deficiencies in certification of causes of death, which could compromise accuracy of statistics obtained from death certificates. Mechanisms by which these deficiencies can be prevented or corrected are discussed.

Adult↗
PubMed1997

[The evaluation of autopsy in the pediatric intensive unit].

OBJECTIVE: Because of concerns about the declining autopsy rate, an attempt was made to evaluate the contributions from the postmortem examination in children. PATIENTS AND METHODS: We carried out a retrospective comparison analysis between clinical and pathological diagnosis of 56 consecutive autopsies performed on children who died in the PICU during the period 1983-1995. RESULTS: The autopsy rate was 60%. Autopsy provided valuable clinical information in 50% of the cases. There were major diagnostic errors in three patients (5%), that if detected before death would probably have improved survival. Another 14 cases (25%) showed missed clinical diagnoses related to the basic illness and the cause of death, whose premortem diagnosis would not have prolonged survival. There were no diagnostic discrepancies in 28 cases (50%). The most unexpected findings revealed by the autopsies were iatrogenics (10 cases), metabolic diseases (4 cases), congenital immunodeficiency syndromes (4 cases) and pulmonary opportunistic infections (3 cases). Eight of these diseases were genetic. An age < 12 months or and ICU stay < 24 hours were not predicting factors of a higher incidence of major diagnostic errors. CONCLUSIONS: The value of the autopsy as quality assurance and to detect iatrogenics and occult genetic diseases is unquestionable. New strategies have to be designed to increase the rate of autopsies.

Autopsy↗
PubMed1997

[Report on medico-legal data from the mass-investigation performed by the Medico-Legal Society of Japan (XIV). Autopsy cases of traffic accidents in Japan (1990-1994). Planning and Development Committee of The Medico-Legal Society of Japan].

Autopsy findings in 3, 185 cases of death due to traffic accidents obtained from all institutions belong to the Medico-Legal Society of Japan between 1990 and 1994 were analyzed statistically. The results are summarized as follows: 1) The annual number of autopsy cases related to traffic accidents was stable and accounted for 10% of all autopsy cases examined. The autopsy cases also accounted for only 6% of all deaths due to traffic accidents. Cases requiring judicial autopsy are few despite the fact that deaths due to traffic accidents are considered deaths resulting from professional negligence. 2) The purposes of autopsy were, in a decreasing order of frequency, (1) to examine whether the accident was a hit-and-run case, (2) to examine whether the case was multiple accidents, and (3) to clarify the relationship of death with the accident. 3) According to the age, those who were involved in accidents while they were on foot overwhelmingly aged 70 years or above, and those who were involved in accidents while they were riding motorcycles were predominantly in their teens to the 20's. Concerning the situation of the accident, run-over cases, were frequently those in their 40's, and collision cases were predominantly those in their 70's. Among those who died in cars, the drivers were most frequently those in their 50's, followed by those in their 20's. 4) The degree of external and internal injuries was compared. About half the victims sustained severe injuries both internally and externally, and the remaining half sustained mild external injuries and severe internal injuries. Run-over cases generally had severe injuries both internally and externally, but collision cases tended to have mild external injuries and severe internal injuries. 5) The most frequent cause of death was brain injury, followed by loss of blood and traumatic shock. 6) Tire marks were observed in 23% of the run-over cases, and they were observed in the head, face, neck, and thoracoabdominal region in most cases. 7) Of the collision cases, collision injuries were observed in 55.6%, and the sites of collision injuries were the crural and femoral regions. 8) Of those who died in the car, about 46% were the drivers. 9) Deaths while driving due to internal causes accounted for 3% of all autopsy cases who died in traffic accidents, and ischemic heart disease was the most frequent of the internal causes. 10) Concerning injuries caused by safety devices, 3.5% of the drivers and 4.4% of non-driver passengers were injured by the seat belts, and 3.9% of those who were riding motorcycles were injured by the helmets. 11) Alcohol was detected from 47.7% of the cadavers examined, and the alcohol level was 0.5 mg/ml or above in 19% of those driving and 50.2% of those on foot. 12) Stimulants were detected in 5 (3.8%) of 132 cases examined, and thinner was detected in 17 (13.0%) of 131 cases examined.

Accidents, Traffic↗
PubMedDate not supplied

Autopsy audit in a teaching hospital in Nigeria--the Benin experience.

A one year prospective study was carried out to compare clinical diagnosis antemortem with autopsy diagnosis post-mortem in all patients coming to autopsy. In the study period a total of 612 deaths occurred in the hospital out of which 179 came to autopsy representing an autopsy ratio of 29%. Of the 179 cases, 100 (56%) were cases referred to the coroner. A total of 143 cases were analyzed and the concordance rate between clinical and autopsy diagnosis was found to be 54%. We find the autopsy ratio abysmally low and recommend that all effort be made to increase it to 75% and that autopsy audit be officially adopted as a means of quality control in hospitals. We also believe that all concerned should work towards improving our clinical diagnostic ability in order to attain and maintain a concordance rate well above 90%.

Autopsy↗
PubMed2002

Characterization of tissue components in the temporomandibular joint disc and posterior disc attachment region: internal derangement and control autopsy specimens compared by morphometry.

PURPOSE: Our aim was to morphologically investigate the occurrence of fibroblasts, chondrocytes, and blood vessels in the tissue of the temporomandibular joint (TMJ) disc, the intermediate zone, and the posterior disc attachment region in control autopsy specimens and to compare the results with those observed in corresponding tissues from patients with TMJ internal derangement. PATIENTS AND METHODS: First, 20 bilateral TMJ disc specimens from selected autopsy cases were analyzed by conventional morphometry. Thus, the volume density of fibroblasts, chondrocytes, and blood vessels was determined. Second, the obtained results from the right joint of the autopsy disc specimens were compared with 12 TMJ disc specimens obtained at surgery from patients with internal derangement. RESULTS: The tissue compartments of interest (disc, intermediate zone, and posterior disc attachment region) were identified unequivocally in all specimens. None of the autopsy cases showed any significant difference between the right and left joints or related to gender. The only variable that differed between autopsy and patient specimens was volume density of blood vessels, which was higher in patient specimens. CONCLUSIONS: We found that the volume density of blood vessels was significantly higher in the posterior disc attachment region in patient specimens than in autopsy controls. Whether this reflects a role for vessels in the pathogenesis of TMJ internal derangement or merely is a reaction to another type of injury remains to be settled. In both the autopsy control and patient specimens, chondrocytes and fibroblasts were characteristic for disc respective posterior disc attachment region. Thus it appears that the occurrence of these cells can be used to distinguish TMJ disc from posterior disc attachment in small biopsy specimens.

Adolescent↗
PubMed2001

Lack of evidence for an association between neurofibromatosis type I and intracranial aneurysms: autopsy study and review of the literature.

BACKGROUND AND PURPOSE: Neurofibromatosis type I (NF1) is an autosomal dominant, hereditary, neurocutaneous syndrome purported to be associated with intracranial aneurysms. To study the relationship between NF1 and intracranial aneurysms, we have analyzed all intracranial autopsies of NF1 patients performed at our institution from 1889 to 1999 and analyzed all intracranial aneurysm cases at our institution from 1990 to 1999 in an attempt to identify patients with NF1. In addition, we have reviewed published clinical series of NF1 patients. METHODS: The autopsy database at our institution, which contains 50 000 cases from 1889 to 1999, was searched to identify NF1 patients, and the results of these autopsies were reviewed. The prevalence of intracranial aneurysms in these NF1 patients was compared with the prevalence of intracranial aneurysms in our hospital's autopsy population and with the published prevalence of intracranial aneurysms in the general population. To identify patients with intracranial aneurysms and NF1, our institution's intracranial aneurysm database was searched for patients with clinical manifestations of NF1. Published clinical series of NF1 patients were identified through searches of the literature. RESULTS: None of the 25 autopsy patients with NF1 had an intracranial aneurysm. None of the 925 patients treated for intracranial aneurysms were affected by NF1. A review of the literature identified 8 comprehensive clinical studies, all of which failed to document any relationship between NF1 and intracranial aneurysms. CONCLUSIONS: The autopsy prevalence of no NF1 patients with intracranial aneurysms out of 25 is not different from the prevalence of intracranial aneurysms in the general autopsy population. In addition, no patients treated for intracranial aneurysms at this institution had NF1. These findings are supported by the observation that an association between NF1 and intracranial aneurysms has never been identified in 8 large clinical studies of NF1 patients. We conclude that there is a lack of evidence for any association between NF1 and intracranial aneurysms.

Adolescent↗