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At least 55 records · Page 3Linked to original sources
PubMed1997

Improving perinatal autopsy rates: who is counseling bereaved parents for autopsy consent?

BACKGROUND: Concern has been expressed recently about perinatal autopsy rates, which are often below recommended levels. Since a possible reason for the decline in adult autopsy rates is the person seeking permission for autopsy, a study was undertaken to ascertain who were seeking consent and who offered counseling for perinatal postmortem examinations. METHODS: A postal questionnaire survey of members of a support group, Stillbirths and Neonatal Death Society in South Australia, was conducted. RESULTS: The idea for an autopsy was initiated by a physician in 20 of 46 cases and by junior medical doctors, midwives, nurses, or social workers in 22 of 46. Women had further counseling and discussion with physicians in 22 cases, junior medical staff in 10, midwives or nurses in 20, social worker in 9, and support group member in 1. Only 33 of the 46 women thought that they had been counseled about the advantages of the autopsy. CONCLUSIONS: It is important that all health workers involved in counseling the bereaved mother know of the benefits and the mechanics of an autopsy so that consent or refusal is based on informed counseling.

Adult↗
PubMed1994

Accuracy of admission and pre-autopsy clinical diagnoses in the light of autopsy findings: a study conducted in Budapest.

Pre- and post-autopsy diagnoses of underlying cause of death were compared in consecutive autopsies on persons aged 30 to 80 years; 1000 from each of two pathology departments in Budapest. Data on admission diagnoses and on contributory causes of death were also analysed. At autopsy, the percentages of deaths by underlying cause were neoplasms (any site) 34.9%, diseases of the circulatory system 40.2%, digestive system 13.8%, endocrine, nutritional, metabolic or immune systems 2.7%, and respiratory system 2.2%. For these five disease groupings, the percentages of cases diagnosed clinically as the underlying cause of death which were confirmed at autopsy were, respectively, 90.9%, 84.0%, 82.9%, 55.2% and 32.5%. Although, out of 697 cases with an autopsy diagnosis of neoplasia as the underlying cause, there were only 61 (8.8%) where neoplasms were not diagnosed clinically as the underlying cause, this conceals the fact that in 130 (18.7%) the two diagnoses differed as to the site of the primary neoplasm (ICD 3 digit code). The fact that 43% of post-mortem diagnoses (ICD major category) of underlying cause are missed on admission, and that 19% are missed clinically, indicates that improved clinical diagnostic procedures have not diminished the need for high autopsy rates. Morbid anatomy needs to be better resourced.

Adult↗
PubMed2005

[Evaluation of the rate of autopsy and rate of disparity between autopsy results and clinical cause of death in a surgical ward, with the emphasis on necrological review].

OBJECTIVE: To determine the rate of autopsy and the rate of disparity between autopsy results and the clinically determined cause of death in a surgical ward. DESIGN: Descriptive. METHOD: A total of 12,000 patients were admitted to the surgical ward of the Red Cross Hospital, the Hague, the Netherlands, from January 1999 to December 2002. 305 (3%) died during their stay on the ward. By using our standard mortality registration system, it was possible to classify the causes of death, evaluate shortcomings in treatment, and determine the extent of agreement between pre- and post-mortem findings. RESULTS: Permission for an autopsy was obtained for 136 patients (45%). The autopsy rates in patients who died following abdominal aortic surgery, colonic surgery, peripheral artery bypass surgery, and hip surgery were 55%, 63%, 35% and 30%, respectively. In 37 patients (27%), the autopsy report revealed a disparity with the clinical cause of death. Patients who died after abdominal aortic surgery or colonic surgery had disparity rates of 33% and 21%, respectively. Patients who died after peripheral artery bypass surgery or hip surgery had disparity rates of 13% and 7%, respectively. CONCLUSION: The overall rate of autopsy was lower (45%) than in the period 1992-1998 (60%), but remained relatively high in patient groups who were previously found to have a high rate of disparity between pre- and post-mortem findings. Post-mortem examination remains an important tool that can be used to verify diagnosis and treatment and therefore assess the quality of care.

Autopsy↗
PubMed2005

[Unnatural deaths and medicolegal autopsy system--consented autopsy and its future].

UNLABELLED: We actively examine the causes of non-criminal unnatural deaths here at the Department of Legal Medicine in Kitasato University School of Medicine. We dealt with 3565 cases of unnatural deaths during the ten years from 1994 to 2003 (postmortem examinations, 1741 cases; consented autopsies, 1824 cases; autopsy rate, 51.2%). CONTENTS: deaths by diseases, 2291 cases (64.3%); deaths from external causes or others, 1274 cases (35.7%). The autopsy rate of deaths by diseases is 60.7% and that of deaths from external causes or others is 34.0%. Cardiopulmonary arrest on arrival (CPAOA) accounts for about half of total cases (50.8%), that is 1811 cases. Especially, consented autopsies in cases of non-criminal unnatural deaths performed under the permission (autopsy consent) of the bereaved family are highly significant, since they can contribute to society as greatly as judicial appraisal, and can also contribute to undergraduate and postgraduate medical education. Consented autopsy is a procedure that enhances people's recognition of legal medicine in the society and universities. We expect that other universities will establish their own methods of medicolegal activities in the future by referring to our Kitasato University system as a model.

Autopsy↗
PubMed2005

Degeneration of the inferior olive in spinocerebellar ataxia 6 may depend on disease duration: report of two autopsy cases and statistical analysis of autopsy cases reported to date.

This report concerns a clinicopathological study of two autopsied patients with spinocerebellar ataxia 6 (SCA6), and a statistical analysis between neuronal loss of the inferior olive and disease duration of 15 SCA6 autopsy cases reported to date, including the two cases reported in this study. Cases 1 and 2 came from independent Japanese families. Case 1 developed gait disturbance at age 35 years and died at age 78 years; she had a CAG-repeat expansion of the SCA6 gene (25/13). Case 2 presented with gait disturbance at age 68 years and died at age 78 years; he had an expanded CAG-repeat of the SCA6 gene (22/13). Neuropathological examination of both cases disclosed not only neuronal loss of the Purkinje cells and inferior olive, but also some unnoticed features, including cactus-like expansion of the dendrite of Purkinje cells and relative preservation of Golgi cells in the granular layer of the cerebellum. Exploratory statistical analysis between 11 SCA6 autopsy cases with neuronal loss in the inferior olive (average disease duration: 27 years) and four SCA6 autopsy cases without neuronal loss in the olive (average disease duration: 14.5 years) was investigated by Kaplan-Meier estimates of survival and log-rank test, retrospectively. Kaplan-Meier estimates of survival revealed an obvious difference between the two groups. Survival of 10 years after the disease onset was 90.9% in the former 11 SCA6 autopsy cases, but was 50% in the latter four SCA6 autopsy cases. Furthermore, a log-rank test on the two groups disclosed a significant difference (P=0.0450). We postulate that the neuronal loss of the inferior olive in SCA6 may depend on disease duration.

Adult↗
PubMedDate not supplied

Uncertainty of determining mode and cause of death without autopsy: an autopsy study of medically unattended non-medicolegal deaths.

Eighty-seven cases of medically unattended deaths were autopsied and investigated for alcohol and barbiturate after the general practitioner had certified the death. A detailed survey was made by comparing the mode and cause of death before and after autopsy. After autopsy and chemical analysis, two suicides, one accidental death and two unknown modes of death were found (5%). The high proportion of unknown mode of death was due to the fact that police investigations were not made. The cause of death differed in 30%. It was mostly due to overestimation of ischaemic heart disease, especially acute myocardial infarction, cerebral haemorrhage and because the unknown cause of death could be placed in a definite group after autopsy. Estimated acute myocardial infarciton could only be confirmed in 50% of the cases. Neoplastic disorders as the cause of death was seldom found to be erroneous, but malignancy was undiagnosed in 4% of all cases. It is concluded that doctors should not use acute myocardial infarction as a cause of death unless there is reasonable clinical evidence for the diagnosis, that obscure cases of death should be left to medicolegal investigation, and that the reliability of mortality statistics still has to be improved. The autopsy is still valuable to ensure this extra security.

Adult↗
PubMedDate not supplied

Uncertainty of determining mode of death in medicolegal material without autopsy--a systematic autopsy study.

Systematic autopsy was performed in 807 medicolegal deaths where the police had not requested autopsy. In all cases both the cause of death and the mode of death had been reported at the medicolegal external examination. The autopsy revealed differences in the mode of death in about 4% of all cases. This was due in particular to the problems associated with distinguishing presumed natural deaths from accidents and suicide. The cases of "concealed" suicide were found in particular among the higher age groups. However, no characteristic relationship was found between the proportion of differing modes of death and the age groups. All cases of homicide were recognized at the medicolegal external examination. Malignant disease that had not been diagnosed previously was found in about 4% of the cases, the reason being the large proportion of elderly subjects in the material. Syphilitic aortitis that had not been previously diagnosed was demonstrated in about 1% of all cases, and pulmonary tuberculosis that had not been previously diagnosed was demonstrated in 0.7% of the cases. The conclusion is that the results provide no support for replacing the medicolegal autopsy by medicolegal external examination alone, but rather suggest that the proportion of medicolegal autopsies should be increased.

Accidents↗
PubMed2000

Autopsy in elderly psychiatric inpatients: a retrospective review of autopsy findings of deceased elderly psychiatric inpatients in north Cheshire 1980-1996.

In this 17-year review of death certificates of elderly inpatients of a large psychiatric hospital in North Cheshire, the frequency, trend and value of performing autopsies were examined. Details of death certificates were compared with certificates issued after post-mortem examination to see whether an autopsy yielded any additional or relevant information about conditions that are not directly related to death but might well be of importance to public health. The rate of post-mortem examination, at 9.5% of total hospital deaths, did not show any significant trend over most of the review period. The vast majority of autopsies examined had been requested by the coroner and not by the clinicians. The review showed that an autopsy may be of some value in providing more information regarding any underlying causes of death in elderly psychiatric patients, but has no value in ensuring higher rate of the recording of conditions such as dementia, in particular Alzheimer's disease. Selective hospital autopsy in elderly psychiatric patients to verify, neuropathologically, the clinical diagnosis of Alzheimer's disease, will improve our diagnostic accuracy and provide valid statistics to be used in estimating prevalence, trends, risk factors and for use in all aspects of future research into Alzheimer's disease.

Aged↗
PubMed1990

[Autopsy technique and basic legal aspects of autopsy].

Dissection techniques and questions regarding the laws governing autopsy. Autopsy techniques vary. Hamperl's methods, in my opinion, best fulfil the demands of pathology as well as of forensic medicine. In order to obtain more conclusive findings, the dissection of internal organs in several so-called packages, e.g. throat and chest organs and kidneys in the urogenital system, is preferable. Severance of the heart as a means of achieving bloodlessness (Blutleere) should be tolerated only in isolated cases. Some comments on hygienic working methods are in order, not least because of frequent violations in this area. The dignity of the deceased demands hygienic conditions and that the external appearance of the body be reestablished. The removed organs should be returned to the body for burial. Burial should not be used as a means of waste disposal for the institute. The most common and well-known autopsy cases are also dealt with: legal and administrative autopsy. Only forensic autopsy is governed by Para. 87 StPO, albeit incompletely. The definition of the medical examiner is difficult. According to the law on the standardization in Public Health dated 3. 7. 1934 (RGBl. I., p. 531), these tasks should come under the jurisdiction of the health authorities. Since these are not in a position, either from a personnel or material standpoint, to assume these tasks, it is customary, as is the case in the Frankfurt area, for a service contract to be concluded with the director of the institute for forensic medicine. This solution harbours two dangers.(ABSTRACT TRUNCATED AT 250 WORDS)

Autopsy↗
PubMed1985

Multiple primary cancers in autopsy cases of Tokyo University Hospital (1883-1982) and in Japan Autopsy Annuals (1974-1982).

Multiple primary cancers in 30,386 consecutive autopsy cases from 1883 to 1982 in Tokyo University Hospital and 273,796 registered autopsy cases from 1974 to 1982 in Japan were examined. The frequency of multiple primary cancers among all cancers at Tokyo University Hospital was less than 0.5% until 1940. From 1960, it gradually increased, reaching 6.9% (1970-1982). The average age of patients with a single cancer was around 45 years until 1960. Thereafter, it became high, averaging 54.2 years in 1970-1982. The average age of patients with two and three or more primaries in 1970-1982 was 62.1 and 68.5, respectively. As the autopsy rate of cancers in Japan is 11.1% in 1974-1982, the statistics from the Autopsy Registry are highly representative of those in Japan. The frequency of multiple primaries was 5.5% in the Registry and increased year by year (3.6% in 1974 to 7.1% in 1982). The average age of patients with one, two and three or more primaries was 58.9, 66.7 and 69.8. In these two series, the older the patients, the larger was the number of primaries. In multiple cancers, the frequent combination consisted of the stomach, lung, colon, liver, prostate and thyroid. The stomach, lung, colon and liver were frequent primary sites when they occurred singly. The thyroid and prostate were frequent primary sites found at autopsy. Senescence of the Japanese population is suggested as one of the factors for an increase of multiple primaries in the last 20 years.

Adult↗
PubMed1988

Autopsy findings in 68 fatal renal transplant recipients, collected from the annuals of pathological autopsy cases in Japan.

This report describes autopsy findings in 68 fatal renal transplant recipients, collected from the Annuals of Pathological Autopsy Cases in Japan, 1981-1985, published by the Japanese Pathological Society. Direct causes of death in renal transplant recipients were mainly infections, bleeding, rejection, and liver dysfunction. Infectious complications were present in forty-one autopsy patients (60.3%). Bronchitis and pneumonia were the most frequent, followed by general infections and peritonitis. Fungal infections were present in twelve cases (17.6%). Bleeding was present in thirty-three autopsy patients (48.5%). Gastrointestinal bleeding was the most frequent, followed by general bleeding, and brain and/or subarachinoid bleeding. Liver diseases were present in twenty-eight autopsy patients (41.2%).

Adolescent↗
PubMed2000

[Autopsy techniques in congenital heart defects. Influence of prenatal diagnosis on the planning and carrying out of autopsies].

As a result of the quality of prenatal ultrasound and the expanded experience of prenatal diagnosticians, it is possible to observe congenital heart malformations in increasingly greater detail and at an ever earlier stage of gestation [4]. Since it is on the basis of ultrasound findings that decisions to terminate pregnancies are made, it is of cardinal importance that after termination monitoring and confirmation of the prenatal diagnosis be carried out. This need can only be adequately met by autopsy. There are different methods for carrying out autopsies when there is suspicion of a congenital heart defect: a) the Anderson sequential segmental analysis as modified according to the Berlin method; b) use of a special autoptic method corresponding to the ultrasound findings, based on defining a preferred sectional plane; c) stereomicroscopically; or d) microscopically after embedding and preparation of serial microscopic sections. For the pathologist the consequence is that he has to adapt his autopsy method to the ultrasound findings and the age of the fetus. This enables him to determine an optimal, case-based autopsy strategy for each type of cardiac defect, which is essential for monitoring of the prenatal diagnosis. The present paper discusses the various autoptic methods used in cases of congenital heart malformations and the consequences for the pathologist of the continuing improvements in prenatal diagnostics.

Autopsy↗
PubMedDate not supplied

The value of the hospital autopsy. A study of causes and modes of death estimated before and after autopsy.

Among 312 consecutive deaths in a Danish Central Hospital autopsy was performed in the pathology department on 266 cases, i.e. 85%. Retrospectively, the underlying causes of death were estimated from the clinical information alone by an experienced clinician and subsequently compared with the autopsy report. The definite cause of death was determined jointly by the clinician and the pathologist. The clinician's diagnosis was thereby confirmed as incorrect in 18% of the cases if small differences in site and type of malignant tumours were not considered. This is less than in many other investigations, but it is stressed that this could partly be because formal errors in completing the death certificate were avoided. The main causes of death were ischaemic heart disease and neoplasia. Clinical diagnosis of malignant diseases was never found to be erroneous. There was a slight tendency to clinically overestimate ischaemic heart disease, but in general the different errors outweighed each other, so that the total number of different causes of death before and after autopsy was nearly the same. The original death certificate was investigated in 12 accidental cases. Hereby it was found that the mode of death was originally stated erroneously as natural in 7 cases, i.e. 4.5%. It is concluded that hospital autopsy is still needed for the control and correction of causes of death, and it is stressed that clinicians as well as pathologists should be more aware of cases with a trauma in the history to avoid errors in the mode of death. Such errors can imply legal as well as insurance problems.

Accidents, Home↗
PubMed2000

[Autopsy in peri- and neonatology--an essential step in quality control. Data on autopsy frequency in Saxony].

In the framework of a general quality assurance compaign the working group for peri- and neonatology at the General Medical Council of Saxony has investigated the frequency, conclusiveness and development of autopsies in Saxony between 1992 and 1997/98. There were observable different autopsy rates depending on the degree of neonate maturity. Thus, the autopsy rate of stillbirths having birth weights from 500 to 999 g amounted to 79.7%, and that of stillbirths above 1000 g birth weight to only 59.4%. The abduction rate of neonates dying before day 7 of life was 65.7%. It is remarkable that the abduction rates declines from 79.1 to 62.9% in all weight classes of premature and full-term neonates from 1992 to 1997. The possible reasons for the decline of autopsies and the problems emerging for quality assurance are discussed.

Autopsy↗
PubMed1988

Autopsy study of the elderly institutionalized patient. Review of 234 autopsies.

Autopsies are performed much less frequently in the elderly than in younger patients. Little information exists as to causes of death in the institutionalized elderly. The clinical diagnostic error rate documented by autopsy studies ranges from 6% to 68%. We analyzed the clinical and autopsy records of 234 patients who died during a 14 1/2-year period at our chronic care institution to determine the accuracy of clinical cause of death in addition to the pathologic cause of death. The most common causes of death included bronchopneumonia (33%), congestive heart failure (15%), metastatic carcinoma (14%), pulmonary embolism (8%), myocardial infarction (7%), cerebrovascular accident (6%), unknown cause of death (8%), and a miscellaneous group (9%). The highest diagnostic error rate was in the underdiagnosis of pulmonary embolism (39% antemortem accuracy rate). The most accurately diagnosed condition was cerebrovascular accident (92% antemortem accuracy rate). Pneumonia was correctly diagnosed antemortem in 73% of the patients studied. These data suggest that serious and potentially treatable illnesses are underdiagnosed in the elderly institutionalized patient and that there is valuable information to be learned by performing autopsies in the elderly population.

Aged↗
PubMedDate not supplied

Autopsy as clinical quality control: a study of 15,143 autopsy cases.

The results of autopsy records at the Institute of Pathology of Münster University documented between 1961-70, 1978-87 and 1988-92 were compared with the documented clinical diagnoses of these cases. In the decade 1961-70, 23% of clinical diagnoses were found incorrect (with therapeutic relevance). In the decade 1978-87, the error rate was 18% and in 1988-92, 12%. The difference between the three groups was statistically significant (p < 0.01). Specific data were assembled for the main malignant tumor types. With respect to infectious diseases, the agreement between clinical and autopsy diagnosis is even poorer. Lues (syphilis) is now rarely recognized in clinical diagnosis, even if it is fatal. Merely 50% of all patients with active tuberculosis as primary disease and cause of death, had been diagnosed clinically. Endocarditis in all its forms was underdiagnosed clinically in 75% of the cases. In view of the widely ranging discussion about the value of autopsy today, and in view of the fact that in epidemiological studies the correctness of in vivo diagnosis is tacitly presumed, it has to be stated that autopsy is the best quality control for progress in clinical medicine.

Adolescent↗
PubMed1995

[Survey of clinical diagnoses and autopsy findings. Autopsy findings and sensitivity, specificity and predictive values for clinical diagnosis during the periods 1 July 1980-30 June 1081 and 1 July 1990-30 June 1993].

The sensitivity, specificity and clinical accuracy of clinical diagnoses were determined and compared for two periods of time: 1.7.1980-30.6.1981 and 1.7.1990-30.6.1993 based on the analysis of 286 and 138 autopsies respectively. The autopsy rate decreased from 82.7% in the first period to 11.2% in the second. The first period shows a generally higher sensitivity and accuracy for positive diagnosis. Both periods reveal the lowest sensitivity for pulmonary embolism and the lowest accuracy for positive clinical diagnosis of pneumonia/bronchopneumonia. For malignancies and arteriosclerotic heart diseases significant discrepancy between the periods was demonstrated using the chi 2-test. The results are influenced by low autopsy rates causing fewer true-positive diagnoses and a declining sensitivity. This type of study is a useful tool for demonstrating changes in the diagnostic procedure. The present investigation demonstrates a need for further analysis of malignancies to explain the simultaneous decrease in sensitivity, specificity and accuracy in spite of an increasing number of malignancies in autopsy findings.

Autopsy↗
PubMed1989

[An autopsy case of rectal cancer receiving cisplatin at total dose of 3.250 mg and platinum concentrations in autopsy tissue samples].

An autopsy case of a 57-year-old man who had received cisplatin, total dose of 3,250 mg (1,920 mg/m2) after proctectomy for advanced rectal cancer with hepatic metastasis is reported. Platinum concentrations in autopsy tissue samples are also reported. Cisplatin at a dose of 20-40 mg was administered intravenously once a week for 82 weeks, but renal failure did not occur. The patient died 529 days after his last cisplatin therapy, due to acute suppurative cholangitis. On autopsy, the hepatic hilar metastasis involved the bile duct, but the other metastasis of the liver became regeneration and necrosis, and the kidneys showed few findings but congestion and arteriosclerotic change. The spleen evidenced mild hemosiderosis. Tissue samples obtained at the time of autopsy were assayed for platinum using flameless atomic absorption spectrometry. The spleen had the highest concentration, about 2.7 times as high as that of the liver. The liver, the heart and the kidneys had high platinum concentrations (greater than 3.04 micrograms/g), but those of the jejunum and the ileum were low (less than 0.95 micrograms/g). Although cisplatin, FT 207 and krestin were effective for the rectal cancer, platinum was undetectable (less than 0.13 micrograms/g) in the ascending and the transverse colons.

Adenocarcinoma↗