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PubMed1994

Racial difference in cardiac sarcoidosis incidence observed at autopsy.

The most commonly involved organ in sarcoid related death has been reported to be the lung in western countries, while it was the heart in the Japanese autopsy series. In order to verify this different pattern of death, autopsy records were reviewed in two United States institutions and in Japanese nation-wide data. In Japanese, male to female ratio was 1:2 and a high frequency of sarcoidosis in females over 50 years of age was observed. Male to female ratio in Caucasian sarcoidosis autopsy was nearly 1:1. In Afroamericans, it was nearly 1:2, and the age distribution showed that this female predominance was due to a high number of sarcoidosis in females over 40 years of age. The frequency of sarcoidosis in Caucasian autopsies was higher than in Japanese autopsies. The number of involved organs was smaller in Caucasians than in Afroamericans or in Japanese. The incidence of cardiac sarcoid granuloma in Japanese was significantly higher than that seen in Caucasians and Afroamericans. The commonest cause of death in sarcoidosis of Caucasians and Afroamericans was from non-sarcoid diseases, while the major cause of sarcoid-attributed death was pulmonary sarcoidosis in Afroamericans. Japanese showed the highest rate of cardiac sarcoid-attributed death. Possible factors relating to this high incidence of sarcoidosis in elderly females and the racial difference in cardiac sarcoidosis were discussed.

Adolescent↗
PubMed1993

[The number of autopsies at the Chemnitz Institute of Pathology before and after unification (1987-1992)].

The numbers of autopsies performed at the Institute of Pathology in Chemnitz before and after German unification (1990) were compared (1987-1992). In 1991 and 1992 a decrease of up to 40% was observed. In the former GDR an autopsy was possible without agreement of the relatives, whereas since unification the relatives have the power to forbid an autopsy. This was the principal reason for the dramatic decline in the past 2 years. Another relevant factor is the difficult economic situation of most hospitals in the region, preventing the arrangement of more autopsies. Analysis also shows the important role of physicians in clinics regarding the autopsy rates.

Adolescent↗
PubMed1993

An implementation plan for autopsy quality control and quality assurance.

The few guidelines that exist for performing autopsy quality assurance are vague. Much has been written about the use of the autopsy to monitor clinical services, but not how to monitor the quality of the autopsy and autopsy reports. We present the comprehensive quality assurance program that has been developed and implemented at Hahnemann University Hospital, Philadelphia, Pa, for the past 2 years; this program has encompassed quality control of our diagnostic work. Key features have included in-depth peer review of completed reports, documentation of review at conferences, and careful monitoring of turnaround time. We have found that integrating quality assurance into departmental conferences is a useful supplement to in-depth peer review of randomly chosen autopsies. Our approach to quality assurance may serve as a model for other pathology departments, particularly those with pathology residency training programs.

Autopsy↗
PubMed1996

The autopsy. Some ethical reflections on the obligations of pathologists, hospitals, families, and society.

Since the 18th century, the autopsy has been seen as an essential tool for advancing medical knowledge and monitoring the quality of patient care. In recent years, based on the mistaken assumption that newer diagnostic antemortem procedures, especially imaging techniques, have rendered the autopsy obsolete, it has fallen into serious disuse and disrepute. Data disproving this assumption are now emerging. The autopsy is still needed as a final test of the newer diagnostic techniques and as a means for integrating anatomic, physiologic, biochemical, and clinical features of new, as well as established, diseases. This essay examines the sources of clinicians' and pathologists' moral obligations to obtain, perform, and attend autopsies. It underscores the ethical responsibilities of families, hospitals, and society to restore the autopsy to a place of importance in the elaboration of the natural history of human disease.

Attitude of Health Personnel↗
PubMed1996

The role for regional autopsy centers in the evaluation of covered deaths. Survey of opinions of US and Canadian chairs of pathology and major health insurers in the United States.

OBJECTIVE: To evaluate the advantages and disadvantages of, as well as the attitudes of health care professionals and insurers toward, the development of regional autopsy services. DESIGN: Survey of 150 medical school departments of pathology in the United States and Canada and 12 representative major health insurers in the United States. RESULTS: Of the 25 respondents from the pathology departments, most were in favor of regionalization of autopsy services, if properly underwritten. Of the five respondents from the health insurers, most were disinterested in the autopsy as a measure of outcome and unwilling to provide support. CONCLUSIONS: Health care is being regionalized around networks of insurers rather than hospitals. The networks are defined by a mixture of hospitals, physician groups, and other health care professionals. Within networks, the goal is to subscribe groups of patients, covered lives, for all medical needs from primary to complex care. As the economic risk of caring for patients is shifted to physicians, the incentive to provide service at the lowest possible cost grows, as does the need to assure that medical mismanagement does not occur. To provide quality care at affordable costs, it is necessary that outcomes, including deaths, be professionally evaluated. The present system of death investigation involves hospital colleagues and is potentially biased. Regional autopsy centers that provide timely expert information should be part of the health care system. Medical schools are potential sites for regional autopsy programs because they have the personnel needed to conduct appropriate death-related studies. Most schools are affiliated programmatically and economically with surrounding hospitals and physicians in a manner in which outcomes, costs, and quality of clinical service are of common interest.

Attitude of Health Personnel↗
PubMed1996

Autopsy. A crucial component of human clinical investigation.

OBJECTIVE: To determine the proper role of human clinical investigation, including autopsy, in public health research policy. DATA SOURCES: Medical reports and reviews, and literature concerning the philosophy of medicine. CONCLUSIONS: Autopsy has always been a cornerstone of medical research. Although many pathologists appreciate the research value of autopsies, many other physicians do not. Declining federal support for human clinical research in general, and autopsy in particular, party reflects the popular view that laboratory experimentation-especially that performed on nonhuman animals-can reliably model human conditions. Human clinical research is often difficult, expensive, and time-consuming, but there seems to be no adequate substitute for studies of naturally occurring human conditions. Such studies address many critical medical questions. Autopsy remains an invaluable complement to evolving molecular biology techniques.

Animals↗
PubMed1995

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

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

Alzheimer Disease↗
PubMed1996

Prevention of occupational cyanide exposure in autopsy prosectors.

Autopsy prosectors examining individuals with cyanide poisoning are at risk for occupational cyanide exposure. No protective autopsy precautions to mitigate this risk have been published. We report an autopsy on an individual with cyanide poisoning where the procedure was performed in a negatively pressured isolation room and the stomach was opened under a biosafety cabinet hood. None of the three autopsy prosectors had measurable cyanide in pre or post procedure blood specimens. We recommend that similar precautions be taken in all autopsies where cyanide is suspected as a possible cause of death.

Adult↗
PubMed1998

[The role of clinical autopsy in monitoring the quality of the clinical diagnosis in an emergency department].

OBJECTIVE: A total of 61 autopsies performed in patients died in emergency department of a university hospital were retrospectively analysed and the findings were compared with clinical diagnoses. METHODS: Sensitivity and specificity of the clinical diagnoses and the correction of medical procedures were measured. The influence of age and sex of patients was analyzed using Fisher's exact test and chi-square-test. RESULTS: The most common causes of death were cardiovascular diseases (52.46%). Autopsy showed unexpected major findings in 44.26% of cases. Major discrepancies between the autopsy reports and the clinical diagnoses, were present in 26.22% of all cases. Absolute concordance between clinical and autopsy diagnoses was obtained in 44.26% of cases. The major sensitivity of clinical diagnosis was found in cerebrovascular disorders (100%), upper digestive hemorrhage (100%), and acute myocardial infarction (82.35%). The lowest sensitivity was found in malignant tumors (16.66%), hemorrhagic pancreatitis (0%) and bowel infarction (0%). The patient cares were correct in 68.85% of cases. No statistically significant differences were observed in relation to age and sex. CONCLUSIONS: We concluded that autopsy is a useful method for evaluate diagnostic procedures and quality of medical cares in emergency departments.

Adult↗
PubMedDate not supplied

Does autopsy of antenatally diagnosed malformed foetuses aid genetic counselling?

BACKGROUND: Many pregnancies are terminated because of ultrasonographic diagnosis of malformation in the foetus. A detailed foetal autopsy is needed to arrive at a definite diagnosis on the basis of which genetic counselling can be provided. METHODS: Sixty-one foetuses, terminated because of antenatal diagnosis of congenital malformations by ultrasound, were autopsied. The ultrasound diagnosis was compared with the diagnosis reached after autopsy. RESULTS: In 31 cases (51%) the autopsy provided additional findings. In 21 cases (34.4%), the autopsy changed the primary diagnosis. The revised diagnosis led to a change in the risk of recurrence in 18 cases (29.5%). CONCLUSION: Genetic counselling depending solely on ultrasonographic foetal diagnosis may be erroneous. For appropriate genetic counselling, a detailed foetal examination should be carried out after termination in cases with ultrasonographically detected congenital malformations.

Autopsy↗
PubMed1981

Autopsy findings in 111 cases of esophageal cancer.

Autopsy findings for 111 cases of esophageal cancer are presented. Residual tumor in the esophagus was present in 75% of the cases. Lymph node metastases were found in 74.5% and visceral metastases in 50% of the cases. Autopsy revealed a second primary tumor in 21% of the cases; 12% of these were oropharyngeal-laryngeal (OPL) carcinomas, and 9% were visceral carcinomas or malignant lymphomas. Nonmalignant disease found in association with esophageal cancer was dominated by conditions related to chronic alcoholism. Autopsy findings thus revealed that the patients bore not only esophageal lesions, but also patterns of other associated malignant and nonmalignant diseases which would seem to correspond to a complex pathologic state occurring in association with chronic alcoholism. The time between onset of symptoms and autopsy averaged 10.6 months and between first consultation and autopsy, 6.3 months. The brevity of survival from onset of symptoms would seem to confirm that by the time esophageal cancer manifests clinically, it is already at a stage of development beyond the scope of treatment.

Aged↗
PubMed2002

Incidence of autopsy findings in unexpected deaths of children and adolescents.

Studies in various settings reveal that a significant percentage of autopsies demonstrate findings that were not previously clinically diagnosed. In the pediatric and adolescent age group, forensic examinations comprise a large percentage of total autopsies performed. We hypothesized that a similar number of previously undiagnosed findings would be present in this population and thus reviewed a series of autopsy reports from the Medical Examiners Office in the Arkansas Crime Laboratory. During 1997 through 1999, we performed 439 complete forensic autopsies on children and adolescents (age range 1 day to 19 years; median 18 months). Previously undiagnosed lesions were found in 173 (39%). Of these subjects, 68 (39%) had clinically significant pathology, 60 (35%) had insignificant pathology, and 45 (26%) had pathology of undetermined significance. Thirty-six subjects had lesions expected from a previously diagnosed condition. Of the total number of lesions found, 168 were inflammatory, 58 were congenital anomalies (48 unexpected), and 88 comprised miscellaneous other conditions. Infants <6 months of age were significantly more likely to have a previously undiagnosed lesson than children > 6 months (P <0.0001). Previously undiagnosed findings, mostly inflammatory, occur relatively frequently in pediatric and adolescent forensic autopsies and are more likely to occur in infants.

Adolescent↗
PubMedDate not supplied

Pulmonary embolism in the nursing home population: high frequency at autopsy in female residents.

Pathological and clinical findings of all consecutive autopsies performed at The Jewish Home and Hospital for Aged from 4/1/85 to 12/31/86 were reviewed to determine the frequency and clinical significance of pulmonary embolism as a cause of death in the nursing home. The autopsies were performed by a single pathologist and a diagnosis of pulmonary embolism (PE) was based on microscopic confirmation of macroscopic findings. All charts during this time period were reviewed for classic signs and symptoms of PE, presence of risk factors associated with PE, ambulatory status and rapidity of death. The autopsy rate during this period was 25.6%. Of 41 autopsies reviewed (31 females and 10 males) 14 cases of pulmonary embolism were found representing a prevalence of 34.1%. All occurred in females. Pulmonary infarction was present in four cases. Massive PE (interrupting blood flow to both lungs) and major PE (interrupting flow to one entire lung) made up 11 of the cases (26.8% of all autopsies). Classic symptoms were not more frequent premortem in those with PE than those without PE. The presence of risk factors, or rapid death, or bedbound state did not predict the presence of PE. In none of the cases was the diagnosis established premortem. Elderly female residents of chronic care facilities appear to be at special risk of death from pulmonary embolism. Clinical findings are not of a diagnostic nature.

Journal Article↗
PubMed1980

Present state of fungal infections in autopsy cases in Japan.

In order to clarify the present state of opportunistic fungal infections increasing in incidence in autopsy cases, all autopsy cases from 1966 to 1975 reported in the Annual of Pathological Autopsy Cases in Japan were reviewed. Of the total 233,130 autopsy cases, mycoses were present in 4,340 (1.86%). The incidence of mycoses has strikingly increased during the recent five-year period. In Japan, the mycoses most frequently occurring in autopsy cases were candidiasis (32.28%), aspergillosis (23.08%), cryptococcosis (9.63%), and mucormycosis (2.90%). These occurred more frequently in younger persons and were most commonly secondary and deep-seated infections (95.78%). Among the primary diseases associated with mycoses, aplastic anemia (14.36%), leukemia (9.89%), malignant lymphoma (5.73%), multiple myeloma (4.68%), and systemic lupus erythematosus (4.62%) were most frequent. The incidence of the primary diseases associated with mycoses is increasing extraordinarily, and this seems to be strongly related to the modern therapy of using high doses of anticancer or immunosuppressive agents.

Adolescent↗
PubMed1996

Verbal autopsy as a tool for diagnosing HIV-related adult deaths in rural Uganda.

BACKGROUND: In general, information on the causes of adult deaths in developing countries is scarce. More specifically, relatively little is known about the effect of HIV-1 associated disease on adult mortality in general populations. In this study we have used a verbal autopsy technique to ascertain whether adult deaths were associated with HIV-1 in a rural population with a prevalence of HIV-1 infection of 8%, and used HIV-1 antibody status to validate the verbal autopsy findings. METHODS: All adult deaths in the population cohort that occurred between December 1990 and November 1993 were identified through a monthly death registration system. Approximately 2 months after death, a relative of the deceased was interviewed by a trained nurse, and questionnaires were assessed by at least two independent clinicians; all were unaware of the HIV serostatus of the deceased. RESULTS: A total of 155 adult deaths was assessed, i.e. 53% of all recorded adult deaths. Of those assessed half were HIV-1 positive. In all 47% of deaths were classified as HIV-related. The overall specificity and positive predictive value of the verbal autopsy tool were both 92%; in those aged 13-44 years (83 adults) the corresponding values were 85% and 95% respectively. The verbal autopsy estimated HIV-1 attributable mortality fraction was similar to the calculated fraction based on prospective data. CONCLUSIONS: The results of this study suggest that verbal autopsy studies may assist in providing data on HIV-associated mortality in general populations and may be useful as surveillance tools.

Adolescent↗
PubMedDate not supplied

Primary liver cancer in non-cirrhotic liver. Epidemiological study based on autopsies performed in Trieste, Italy and Kurume, Japan.

This study, aimed at elucidating the epidemiological features of primary liver carcinoma developing in non-cirrhotic livers, was based on 25,103 autopsies performed between 1975 and 1984 in Trieste, Italy. These autopsies correspond to approximately 70% of all deaths that occurred in this area. Various factors allegedly related to carcinomas were analysed in reference to our previous study on cirrhotic livers and in comparison with 5,603 autopsies in Kurume, Japan. There were 28 cases of hepatocellular carcinoma (HCC), 16 of cholangiocellular carcinoma (CCC) not associated with cirrhosis in Trieste, and 48 HCC and 19 CCC in Kurume. On the basis of our findings, it was concluded that cirrhosis, regardless of its cause, is the main pathogenetic factor in HCC; it is responsible for a much higher frequency (14.2:1) than in non-cirrhotic livers, as well as for early occurrence of tumours (an average of 6 years earlier in cirrhotic liver) in Trieste. Patients in Trieste were older than those in Japan, and the frequency of HCC among all autopsies was much greater in the latter. By contrast, the influence of cirrhosis on cholangiocellular carcinoma (CCC) was negligible, as such association appeared purely coincidental or absent. The incidence of CCC among autopsies was greater in Japan. Our data on CCC were not sufficient to demonstrate any clear aetiopathogenetic association between this tumour and alcohol abuse and hepatitis B virus (HBV) infection, except for a possible aetiological role of gallstones. The frequency of CCC relative to HCC was greater in Trieste than in Japan; the incidence of HCC was much less in Trieste, whereas CCC was more frequent in Japan.

Adenoma, Bile Duct↗
PubMedDate not supplied

Pathology of the spleen in primary biliary cirrhosis: an autopsy study.

Pathologic changes of the spleen in primary biliary cirrhosis (PBC) were studied using autopsy cases. By analysis of the data complied in the Annual Registry of Autopsies of Japan (1977-92), it was found that the splenic weight of 184 cases of PBC (450 +/- 224 g) was significantly heavier than that of 41 control autopsy cases of non-biliary liver cirrhosis from the School of Medicine, Kanazawa University (341 +/- 189 g), and also of 210 control cases filed in the Annual Registry of Autopsies of Japan (1982; 334 +/- 174 g). Among the cases of PBC, the splenic weight was positively correlated with the liver weight. There was no significant difference in the splenic weight between the cases belonging to histologic stages 1-3 and those of stage 4. Fibrosis extending from the splenic trabecula, proliferation and dilatation of the splenic sinus, and congestion in the red pulp, all being compatible with chronic splenic congestion, were similarly observed in the spleen in PBC as well as in other non-biliary cirrhotic cases. The present study indicates that the PBC patients present splenomegaly in the non-cirrhotic histologic stage and splenomegaly persists thereafter. However, the histopathologic changes of the spleen peculiar to PBC were not specified in this autopsy study. Prolonged portal hypertension and other mechanisms, possibly related to immune disarrangement, may be responsible for the prominent splenomegaly in PBC.

Adult↗
PubMed1992

Delayed increases in liver cirrhosis mortality and frequency of alcoholic liver cirrhosis following an increment and redistribution of alcohol consumption in Finland: evidence from mortality statistics and autopsy survey covering 8533 cases in 1968-1988.

Changes in the legal restrictions for alcohol consumption in 1969 liberated purchasing and marketing of low-alcohol beer. Subsequently, within the space of 5 years, the per capita consumption of absolute alcohol increased from 4.2 to 6.5 liters. To evaluate the possible effects of this change upon liver cirrhosis mortality as well as prevalence of liver cirrhosis in autopsy series, we surveyed mortality statistics and data from 8,533 medicolegal autopsies in 1968 through 1988. Liver cirrhosis mortality statistics revealed a highly significant (p less than 0.001) increase from 6.4 to 13.7 per 100,000 during the period, and similarly, the prevalence of liver cirrhosis in the autopsy series showed a highly significant (p less than 0.001) increase from 3.0% to 6.1%. More specifically, this increase was attributable to a highly significantly (Chi-square 15.4, p less than 0.001) increased proportion of alcoholic liver cirrhosis occurring at a younger age and almost exclusively in males. The stepwise mode of increase as well as the changes in sex and age distribution of cirrhosis since 1969 could be interpreted as an effect of distribution of consumption to a new generation of consumers. The forensic autopsy series seemed to reflect changes in per capita consumption with a shorter time lag than with mortality statistics. Additionally, only 7% of the 448 cirrhotics singled out from this material exhibited liver cirrhosis as a cause of death and were thus also included in the official mortality statistics, suggesting the greater accuracy of our forensic autopsy series.

Adult↗