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PubMed2002

Value of a complete sonographic survey in detecting fetal abnormalities: correlation with perinatal autopsy.

OBJECTIVE: To determine the sensitivity of using a complete anatomic sonographic survey in detecting fetal abnormalities via correlation with perinatal autopsy results. METHODS: All perinatal autopsies (1994-2001) with positive findings for at least 1 fetal abnormality and performed by a single perinatal pathologist at our institution were retrospectively reviewed. From these cases, singleton fetuses who received prenatal sonography solely in our unit were identified. The sensitivity of sonography in detecting anomalous fetuses as well as fetal abnormalities and abnormalities by organ system was determined. Abnormalities were classified as major or minor In addition, findings from sonography and autopsy were compared, and their correlation was assigned to 1 of 3 categories. RESULTS: Of 88 fetuses identified, 85 had 1 or more abnormal structural sonographic findings (sensitivity for fetuses with anomalies, 97%). A total of 372 separate abnormalities were found on autopsy; of the 299 major and 73 minor abnormalities, prenatal sonography showed 224 (75%) and 13 (18%), respectively. There was either complete agreement or only minor differences between sonographic and autopsy findings in 57 (65%) of 88. The sensitivity of sonography in identifying abnormalities was greater than 70% in these systems: central nervous system, cardiac system, urinary system, extremities, genitalia, ribs, and hydrops. CONCLUSIONS: In experienced hands, sonography has 97% sensitivity in detecting anomalous fetuses when compared with perinatal autopsy results. Although the sensitivity of sonography in detecting major fetal abnormalities is 75%, the sensitivity for minor abnormalities is poor, even when using a complete anatomic sonographic survey. Although it has limitations, this type of survey is invaluable for both patients and physicians in diagnosing fetal abnormalities.

Abnormalities, Multiple↗
PubMed2006

Comparison of clinical causes of death with autopsy diagnosis using discrepency classification.

OBJECTIVE: To determine the usefulness of autopsy findings in the quality improvement of patients care. DESIGN: An observational study. PLACE AND DURATION OF STUDY: Departments of Pathology and Medicine, Combined Military Hospital (CMH) Kharian, a tertiary care hospital, from January 2001 to December 2003. MATERIALS AND METHODS: The clinical and necropsy findings of all the cases, who died in hospital and had undergone autopsy examination at CMH, Kharian, from January 2001 to December 2003, were retrieved from record of clinical case sheet data and autopsy record of the hospital. The two were analyzed and compared according to the discrepancy classification. The exclusion and inclusion criteria, the international classification of disease (ICD) to code deaths, the global burden of disease (GBD) system to classify and group diseases, and the Goldman discrepancy classification to compare clinical and autopsy diagnosis and classify the discrepancies, were used as described. RESULTS: The death rate varied from 0.94% to 1.29% and autopsy rate from 4.69% to 10.10% annually between January 2001 and December 2003. The number of cases classified according to GBD system was 3 (5%) in Group 1, 26 (43.33 %) in Group 2 and 31 (51.66 %) in Group 3. The discrepancy classes included 9 (15 %) class I major discrepancies and 3 (5 %) class II major discrepancies. Non-discrepant diagnosis was seen in 37 cases (61.66 %) and 11 cases (18.32 %) were non-classifiable. CONCLUSION: This study showed the usefulness of autopsy findings in the quality improvement of the diagnosis and management of the disease by showing only a minority of cases with discrepant diagnosis of the cause of death.

Autopsy↗
PubMed2000

The autopsy in the 21st century: time for reconsideration.

In recent years, the autopsy rate has dramatically declined. Using three cases, we attempt to explore the current questions concerning the value of the autopsy. The discussion centers around the importance of the autopsy to medicine and family members of the deceased, the impact of technological advances on the autopsy, and discordant pre- and post-mortem diagnoses. We conclude that the decrease in autopsy rates is secondary to underutilization of the autopsy as a diagnostic and educational tool.

Adult↗
PubMed2000

A 12-month review of autopsies performed at a university-affiliated teaching hospital in Hong Kong.

OBJECTIVE: To review the autopsies performed at a university-affiliated teaching hospital over a 12-month period. DATA SOURCES: Records of autopsies performed at a university-affiliated teaching hospital during 1997, and Medline literature search (1966-1998). STUDY SELECTION: The key words used in the literature search were 'autopsy' and 'audit'. DATA EXTRACTION: Data were extracted and analysed by the authors. Any discrepant cases (in which the final diagnoses were either unexpected or not made before death) were identified from the hospital records. DATA SYNTHESIS: Interest in autopsy results has increased, owing to the greater emphasis on medical audit and quality assurance procedures. Of the yearly total of 403 autopsies, 332 cases were reviewed; the discrepancies found were classified as either major or minor, according to their effect on the clinical outcome. The major and minor discrepancy rates were 23% and 9%, respectively. In 2% of cases, the cause of death was due to complications resulting from surgical intervention. These discrepancy rates were comparable to the figures quoted in the literature. CONCLUSION: Autopsy is a valid medical quality-assurance mechanism in Hong Kong.

Autopsy↗
PubMed2000

Attitudes of nursing staff to the autopsy.

We assessed the views of hospital nurses on the autopsy, using a questionnaire which was distributed by hand to all qualified nurses working at Manchester Royal Infirmary during a 48-h period. We found that many respondents (43%) had had occasion to discuss autopsy with relatives, and the majority (90%) would like to learn more about counselling the bereaved. Few (15%) clearly understood the legal distinction between coroners' and hospital autopsies. Almost all (97%) thought the main reason for autopsy was determination of the cause of death, and only 12% supported a role in clinical audit. More respondents saw benefits for doctors rather than for nurses, and only 56% perceived a benefit for relatives. In general, nursing staff have a more positive view of the autopsy than we anticipated, and we would advocate making more information about the benefits of autopsy available to nurses.

Attitude of Health Personnel↗
PubMed1975

[The frequency of autopsies and bioptic examinations in Czechoslovakia from 1964 to 1973 (author's transl)].

The analysis of the routine necroptic and bioptic activities of the pathologists in CSSR shows the following basic facts: 1. The number of patients decreasing with the Public Health Service increases rapidly every year, only one half of these dead might be autopsied. The number of the autopsies increases far more slowely, so that the increase of unautopsied dead is to be expected in the next years. 2. The percentage of the autopsies from the total number of dead in CSSR permanently increases and it represents 32.4% in pathological autopsies and 36% together with the legal-medical autopsies. 3. The number of the bioptic examinations permanently increases. 4. The participation of the pathological institutes of the faculties in the routine necroptic and bioptic activity shows the decreasing tendency (26% ov all autopsies and 35% of all biopsies are performed by above mentioned institutes). This is caused by the foundation of the new pathological department directed by the Public Health Service.

Autopsy↗
PubMed2002

[Prioritization of hospital autopsies].

BACKGROUND: Routines for requesting autopsies in hospitals in Norway differ. At the Central Hospital in Rogaland, physicians usually fill out a form requesting an autopsy when a patient dies. The physician can choose between "high", "ordinary" or "low priority". In this study we investigated which patients were given highest priority and which factors influenced the priority made by the referring physician. MATERIAL AND METHODS: This was a retrospective study. All requests for an autopsy during the year 2000 were reviewed, except forensic medicine cases and perinatal deaths. We included 785 requests in the study. 237 autopsies were performed: an autopsy rate of 30.2%. RESULTS AND INTERPRETATION: The requesting physicians considered 17% "high priority", 44% "ordinary priority" and 39% "low priority". Significantly higher priorities were set for those who died young, those who died after a short stay in hospital, and for those who died in intensive care units. Sex and time of death did not influence priorities. The recommendation required on the autopsy request form leads to more appropriate decisions by pathologists and strengthens the relationship between clinicians and pathologists.

Aged↗
PubMed1992

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

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

Animals↗
PubMed2003

Autopsy findings in a series of five cases of fetomaternal haemorrhages.

AIMS: Fetal blood cells enter the maternal circulation in up to 95% of pregnancies, but usually in minute volumes. Haemodynamically significant fetomaternal haemorrhage (FMH) is a much rarer event reported in approximately 1 in 2800 pregnancies. Most of the literature on this phenomenon emphasises the clinical aspects, and there is no comprehensive description of the autopsy findings. We present a series of five fatal FMH. The aim of this series is to highlight some of the autopsy findings that may prompt consideration of a diagnosis of FMH and lead to appropriate confirmatory testing and counselling of the affected couple. METHODS: The five cases were referred to the Children's Hospital at Westmead for full autopsy. A Kleihauer-Betke test was performed on the mother's blood within one week of delivery in each case. RESULTS: The infants ranged in age from 27 to 40 weeks gestation (mean 36.6 weeks) with a mean birth weight of 2793 g. The estimated volumes of fetal blood lost ranged from 443 to 104 mL (mean loss 243 mL). The estimated percentage of fetal blood volume loss was an average of 107% (i.e., greater than the entire blood volume of the fetus). No other causes of hydrops were identified. Pallor was often noted, and in most cases the autopsies were markedly bloodless with large vessels collapsed. Where the brain:liver ratio could be applied, two fetuses showed a mild increase in ratio, while one infant showed moderate growth restriction with a ratio of 6.2:1 (normal ratio 2.8:1 on non-macerated fetuses over 28 weeks gestation). Placental abnormalities included thrombosis of the umbilical vein and intervillous 'haematomas' in two cases. The most striking microscopic feature was the presence of intravascular nucleated RBC within virtually all organs. Placental intervillous (i.e., within the maternal vascular compartment) nucleated red blood cells were also seen in all cases. CONCLUSIONS: The autopsy findings of FMH can be subtle and easily overlooked unless a high index of suspicion is maintained. The most reliable autopsy features are pallor, subcutaneous oedema or serous effusions, and intravascular nucleated red blood cells (RBC) in organs or more specifically in the placental intervillous space. In all cases of unexplained fetal death a Kleihauer-Betke test should be performed.

Adult↗
PubMed2004

[Analysis of autopsy cases in 50 years].

OBJECTIVE: To evaluate the changing rate for autopsy and the reason during 50 years, and to study the disagreement between pathological and clinical diagnosis in 3162 autopsy cases. METHODS: To retrospectively analyses 3162 autopsy cases in School of Medicine of Zhejiang University from 1950 to 1999. RESULTS: (1) The most autopsy cases is 1037 cases during 1960 - 1970, while the lowest is 102 cases during 1990 - 1999. (2) The total clinical mis-diagnosis rate is 36.24%, while the highest one is 43.19% in 1970 - 1979 group, and 41.80% in 1990 - 1999; The highest diagnostic inaccuracy rate is for tumor (62.42%), second circulation disease (61.81%), third parasitic disease (49.18%); Invasive fungal infection rate in 3162 autopsy is 2.28%, while the diagnostic inaccuracy rate is as high as 86.10%. (3) In disease spectrum, the common diseases are respiratory disease (32.29%), infectious disease (11.61%) and digestive disease (11.07%) respectively. CONCLUSION: The autopsy rate was decreased gradually over 50 years, while the diagnostic inaccuracy rate is still high.

Autopsy↗
PubMedDate not supplied

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

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.

Academies and Institutes↗
PubMed2004

The value of the perinatal and neonatal autopsy.

The postmortem historically has been considered a valuable diagnostic exercise which contributes to medical knowledge. Despite this, there has been a significant reduction in autopsy rates throughout the developed world. This audit was a retrospective study of autopsy reports of stillbirths and neonates [corrected] greater than 500 grams over a five year period from 1995 to 1999. The audit was performed to assess the impact of autopsy on the current practice of perinatal medicine. The audit compared the final pathological diagnosis to the clinical diagnosis. The pathological diagnosis was categorised as (I) diagnostic, (II) confirmative, (III) unexplained. The recurrence risk estimates as a result of necropsy were also identified, as were any additional findings that were felt to be relevant but did not belong to any of the above categories. A total of 262 perinatal deaths (including stillbirths) and neonatal deaths greater than 500 grams birth weight were recorded during this period. The autopsy rate was 81%. The 213 autopsies performed were assessed, of which 76 (36%) were found to be diagnostic, 108 (51%) confirmatory, and 29 (13%) were unexplained or revealed no new findings. Change in recurrence risk estimates was identified in 24 (11%) and additional relevant information was obtained in 38 (18%). There were a number of cases where an unexpected diagnosis was made as a result of autopsy; these diagnoses included a respiratory chain disorder in a twenty nine week infant, and an occult necrotising enterocolitis presenting with severe haemolysis post transfusion in a preterm infant. The perinatal post mortem examination remains an indispensable part of clinical management. It contributes to medical education and quality assurance. It can aid in the identification of inheritable diseases and provide information for accurate parental counseling.

Adult↗
PubMed2005

A 30-year analysis of cardiac neoplasms at autopsy.

INTRODUCTION: Cardiac neoplasms are rare and the vast majority are metastatic in origin. Symptoms of cardiac neoplasms (primary or metastatic) usually appear late in the course of the disease and are often ignored because of the more severe effects of the primary malignant disorder or its therapy. Consequently, cardiac neoplasms, especially metastatic ones, are often not discovered until autopsy. OBJECTIVES: To assess the incidence of cardiac neoplasms at autopsy and to determine the sites of origins of metastatic cardiac neoplasms. METHODS: The pathology records from consecutive autopsies performed at the University Health Network, Toronto, Ontario, from January 1973 to May 2004 were reviewed. They showed 266 cases of neoplasms involving the heart among 11,432 consecutive autopsies. These cases were then categorized based on their system of origin and further subclassified into specific primary site categories. As well, the type of cardiac tissue affected was noted in 193 cases (72.6%). RESULTS: The 266 autopsy cases involving cardiac neoplasms represented 2.33% of the total number of autopsies. Among the 266 cases, two neoplasms were primaries, while 264 were metastatic in origin. Metastatic cardiac neoplasms most frequently metastasized from the respiratory system, followed (in order of decreasing frequency) by the hematopoietic, gastrointestinal, breast and genitourinary systems. A minority of metastatic cardiac neoplasms were found to have spread from other systems. Cardiac neoplasms most frequently involved the pericardium, followed (in order of decreasing frequency) by the myocardium, epicardium and endocardium. CONCLUSIONS: There were 132 times more metastatic cardiac neoplasms than primary cardiac neoplasms found in the present study. The most common sites of metastatic origin were the lungs, bone marrow (leukemia/multiple myeloma), breasts and lymph nodes (lymphoma). Leukemias were more prevalent in the present study than in previous studies. The pericardium was the tissue that was most frequently affected by metastatic cardiac neoplasms.

Adolescent↗
PubMed2005

Bacterial study of autopsy specimens.

Autopsy reports were reviewed for the detection of infectious diseases at autopsy and to determine what extent an infectious process was involved in the patient's death. The present study was performed to analyze bacterial data of autopsy specimens in Siriraj Hospital during 1992-1999. Various autopsy specimens were cultured including heart blood, bronchus, lung, brain, cerebro-spinal fluid, pleural fluid, ascitic fluid, peritoneal fluid, liver, kidney, pericardial fluid, spleen and gall bladder From 781 autopsy specimens 502 (64.28%) were positive for bacterial pathogens. The five most common bacterial pathogens isolated from the present study were nonfermentative gram-negative rods followed by Klebsiella pneumoniae, Salmonella serogroup E, Escerichia coli and Acinetobacter anitratus, respectively. The ante mortem diagnosis by clinicians was correct 56% regarding to retrospectively analysis of septicemia/septic shock versus autopsy culture from heart blood

Autopsy↗
PubMed2006

Correlation of clinical findings and autopsy results after fatal injury from motor vehicular-related crashes.

In the past, autopsy served as the gold standard to document diagnostic accuracy. Although a valuable contributor to medical education, information collected from autopsies is frequently delayed and poorly used. The purpose of this study was to determine the degree of concordance between clinical findings and autopsy results of trauma patients involved in fatal vehicular-related crashes. A 10-year retrospective review of trauma patients involved in fatal vehicular-related crashes who subsequently had an autopsy performed was conducted at an American College of Surgeons-verified Level I trauma center. The clinical record, trauma registry data, and autopsy results were reviewed. Degree of concordance was evaluated using the Goldman Type Errors Criteria. A total of 207 decedents were included (mean age, 41; 63% male; median Glascow Coma Scale score, 3; median Injury Severity Score, 37). The majority (69.6%) of decedents were injured in motor vehicle crashes. Total treatment time was < 15 minutes in 29.0 per cent of cases, < 6 hours in 59.4 per cent of cases, and < 24 hours in 73.9 per cent of cases. Location of death was the emergency department (43.0%), the intensive care unit (49.8%), the operating room (5.4%), and the nursing floor (1.0%). There were no Goldman Class I or IV type errors, (i.e., no major or minor discrepancies, respectively, that may have altered therapy or survival of the patient). Following ATLS-based protocols results in appropriate identification of clinically significant injuries in patients involved in motor vehicular-related crashes. The routine use of autopsy results offers little additional information to a mature American College of Surgeons-verified Level I trauma program.

Accidents, Traffic↗
PubMed1991

Contributions of autopsy to population-based cancer epidemiology: targetted intervention to improve ascertainment.

The importance of autopsy data in cancer epidemiological investigation is well appreciated by researchers at the Mayo Clinic. The Rochester Epidemiology Program Project is a complete population-based collection of morbidity and mortality data in Olmsted County, Minnesota (population, 100,000), funded by the National Institutes of Health since 1964. Comprehensive ascertainment of cancer in this community cohort has been augmented by initial diagnosis at autopsy for 12% of colorectal cancers, 35% of intracranial neoplasms, 45% of phaeochromocytomas and 37% of renal-cell carcinomas. These rates are in stark contrast to autopsy diagnoses in our cancer registry--usually less than 1%. The difference is attributable to the denominator in these comparisons, a concept of vital importance to the epidemiological interpretation of autopsy findings. Despite the enormous value of the autopsy in our research, social and economic factors diminished autoptic rates in Olmsted County from 63% in 1970 to 39% in 1984. These rates are well above that for the USA as a whole but parallel our national decline in frequency of autopsy. The major factors responsible for this reduction appear to be the increasing proportion of deaths in nursing homes and the advent of declining reimbursement in US health care.

Autopsy↗
PubMedDate not supplied

[Autopsy: reflection of intrahospital mortality].

Autopsies have long been viewed as a biased source of information with regard to the mortality statistics that prevail in the hospital and community. This bias could be of either a demographic or clinical nature. Our objective was to define the autopsy characteristics from the National Cancer Institute of Mexico and determine how representative they were of hospital mortality. Age, sex, place of residence, socioeconomic status, and tumor location were obtained from the Hospital Mortality Registry (1985 and 1987). During these two years, 451 deaths were registered; in 290 of these cases (64.3%), an autopsy was performed. Discrepancies of 9.8 percent were found between autopsy diagnosis and mortality registry data. Our results indicate that autopsy examinations effectively reflect total hospital mortality, and represent a useful tool for epidemiological cancer studies in Mexico. Furthermore, we believe that mortality statistics should be based on autopsy results.

Adolescent↗
PubMed1991

The incidence and distribution of Mycoplasma fermentans (incognitus strain) in the Chicago AIDS autopsy series: an immunohistochemical study. Chicago Associated Pathologists.

Mycoplasma incognitus is a recently described organism that was originally isolated by Shyh-Ching Lo from spleen and Kaposi's sarcoma (KS) tissue of patients with AIDS. The mycoplasm has since been found in selected AIDS autopsy cases in which there were tissues with unexplained areas of necrosis. Mycoplasma incognitus is now known to be closely related to Mycoplasma fermentans. In order to determine the incidence and distribution of M. fermentans/M. incognitus in an unselected series, we performed a retrospective immunohistochemical study of 42 HIV-positive autopsies from the Chicago AIDS autopsy series. One case (2.4%) was found to be positive. The patient was a 27-year-old white male homosexual who had no evidence of Kaposi's sarcoma nor of any other neoplastic disorder and who died of Pneumocystis carinii pneumonia. Antigen was present in the macrophages of the patient's spleen, liver, and bone marrow but was not associated with areas of necrosis. All other tissues sampled from this case (brain, heart, testis, lymph nodes) were negative. In the remaining autopsies, organs of the reticuloendothelial system as well as other randomly selected tissues (e.g., lung, heart, testis, pancreas) were screened and found to be negative. Tissues from several non-AIDS autopsies were also found to be nonreactive for M. fermentans/M. incognitus. We conclude that M. fermentans/M. incognitus is not a common agent found in the Chicago AIDS population; that it may be identified in tissue without morphologic abnormality; and that it is not randomly present in non-AIDS autopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗