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PubMed1987

[An autopsy case of triple primary cancers consisting of glioblastoma multiforme of the pons, colon cancer and rectal carcinoid--a statistical analysis of cases of brain tumor combined with other primary cancers in Japan autopsy annuals].

An autopsy case of glioblastoma multiforms of the pons with a colon cancer, a rectal carcinoid, a renal adenoma and three gastric leiomyomas in a 81-year-old-woman is reported with a statistical analysis on multiple primary cancers associated with primary brain tumors as reported in the Japan autopsy annuals. Out of 329, 705 autopsy cases from 1975 to 1984 in the Japan autopsy registry, double cancers and triple cancers that included a primary brain tumor amounted to 123 cases (0.037%) and 12 cases (0.0036%), respectively. Other sites for primary cancers were the thyroid (23%), the stomach (15%), the lungs (12%), and the colon (10%) in that order of frequency.

Adenoma↗
PubMed1980

Chronic granulomatous disease associated with peculiar Aspergillus lesions. Patho-anatomical report based on two autopsy cases and a brief review of all autopsy cases reported in Japan.

Chronic granulomatous disease (CGD) is based on the dysfunction of phagocytes and characterized by a comparatively uniform granulomatous lesion caused by organisms which do not produce hydrogen peroxide and which are catalase-positive. This report describes two autopsy cases in children, a nine year-two month-old boy and a ten month-old girl, with the clinical manifestations and autopsy findings of CGD and a brief review of all autopsy cases consistent with CGD reported in Japan. In these cases, in addition to the usual CGD lesions, there was a markedly different type of granuloma due to Aspergillus sp., which consisted of multinuclear giant cells alone, or a caseous center surrounded by giant cells. This peculiar type of aspergillosis may correspond to a primary infection, described as pseudotuberculosis aspergillina. It appears that in some CGD patients, macrophages may function normally and sometimes be more activated by these infections than in the normal body. The histochemical and electron microscopic examination of the present cases and a review of the previous cases suggest that the yellowish brown pigment found seems to resemble a ceroid. It is a product of the degradation of leukocytes and tissue elements with subsequent accumulation in phagocytic histiocytes and is not necessarily peculiar to CGD.

Aspergillosis↗
PubMed1995

Where have all the autopsies gone? A proposal for a centralized autopsy service.

A litany of reasons have been advanced to account for the decrease in hospital autopsy rates. Increased attention has recently been centered on the difficulty hospital and medical examiner morgues are encountering in controlling infectious disease and attempting to comply with federal and state environmental regulatory agencies. The problem has been highlighted by autopsy examinations upon increased numbers of immuno-compromised patients harboring both the HIV and secondary drug resistant tuberculosis organisms. These developments occur at a time when there are budgetary restraints on hospitals and medical examiners' offices facing large expenditures involving morgue reconstruction to comply with ventilatory and infection control procedures mandated by state and federal agencies. Challenging, also, are the liability aspects, as patients and staff are potentially exposed to a variety of infectious agents. A possible solution is presented involving central off-hospital site facilities to which hospital autopsies can be funneled. A community morgue meeting the strict standards of infection control would allow economy of scale from daily use with a full time support staff trained in the protocol of infectious disease control.

Autopsy↗
PubMed2000

[Autopsy of the fetus. Proposed investigatory strategy as a decision aid in the autopsy of fetues with special conditions].

Prenatal examination of fetuses can now yield excellent findings and, by means of Doppler technology, can also reveal functional changes. Despite progress in fetal diagnostics, quality control of prenatal diagnoses remains necessary since prenatal findings can be the basis for deciding whether to perform preterm abortion. This is possible only by autopsy, and therefore increasing demands for precision are being placed on autoptic procedures. This is particularly the case in malformations, which can be associated with a specific syndrome and then become decisive in the context of family counseling of the parents in question. The pathologist must therefore go beyond the requirements of a standard autopsy in order to obtain thorough findings with respect to the fetus and the placenta. We describe an examination strategy for the stepwise elucidation of special and rare fetal conditions the autopsy of fetuses that is intended to provide support in decision making.

Autopsy↗
PubMed1995

Tuberculosis in the autopsy material: analysis of 1500 autopsies performed between 1972 and 1991 in the Institute of Tuberculosis and Chest Diseases, Warsaw, Poland.

SETTING: The present study is based on 1500 autopsies done in the Institute of Tuberculosis and Chest Diseases Warsaw, Poland during the years 1972-81 and 1982-91. OBJECTIVE: To assess the correctness of tuberculosis diagnosis before death in the above mentioned time periods. DESIGN: The autopsy reports were examined for the diagnosis of active tuberculosis proved by microscopy. The form and localisation of tuberculosis was assessed. The postmortem diagnosis was compared with clinical diagnosis. In those cases in which tuberculosis was not recognised before death the possible causes of this failure were analyzed. RESULTS: Active tuberculosis was found in 119 cases, 7.9% of all autopsies. It was localised in the lungs exclusively in 72 cases, in lungs and in extrapulmonary sites in 45 and in extrapulmonary sites only in 2. The frequency of active tuberculosis was the same for the two periods under evaluation. Tuberculosis was however not recognised before death in a much higher proportion of cases in 1982-92 (54%) than in 1972-81 (24%). The main cause of diagnostic failure was connected with atypical localisation of lesions on chest X-ray and with dissemination outside the lungs. Previous tuberculosis was a factor which facilitated the diagnosis of tuberculosis. CONCLUSIONS: In parallel with the decline of tuberculosis incidence in Poland, many doctors lack experience in diagnosing this disease, especially in cases with atypical X-ray presentation and with extrapulmonary localisation. This may lead to late or even very late diagnosis and have a significant impact on the epidemiological situation.

Adolescent↗
PubMed1993

The meta-autopsy: changing techniques and attitudes towards the autopsy.

The contribution of new techniques to the performance, evaluation and future development of the autopsy as a quality assurance technique are reviewed. Particular emphasis is placed upon psychological techniques and studies that attempt to delineate the attitudes of those concerned with autopsies in various capacities including: medical students; junior doctors; senior clinicians; trainee pathologists and Coroners and their officers. The conclusions are considered in the light of the continuing decline in "hospital" autopsy rates.

Attitude of Health Personnel↗
PubMed1978

Requesting the autopsy: a pediatric perspective. Psychosocial and professional aspects of the autopsy in caring for the dying child and his family.

Many physicians find the request for autopsy to be one of the most difficult and unpleasant aspects of pediatrics. Lack of preparation, their own emotional reactions, and ambivalence about the necessity of autopsies contribute to this. This article offers an approach to the autopsy that emphasizes its importance to families and to pediatrics, and suggests a role for the physician at the time of the child's death that is both professionally and personally gratifying.

Autopsy↗
PubMed2000

[An autopsy case of thymic carcinoma producing various tumor markers and the examination of 222 autopsy cases of thymic malignant tumor in Japan].

The autopsy of a 76-year-old Japanese female patient, which revealed thymic carcinoma with various tumor markers such as NSE, CYFRA, and CA-125, is presented. The patient died from hepatic failure because the liver was overtaken by the tumors. At autopsy, the thymic carcinoma was found to have metastased only in the liver. From microscopical analyses and electron microscopical findings, we diagnosed poorly differenciated squamous cell carcinoma of thymic origin. In the histochemical analyses, the tumor cells were positively stained in CA 125, CA 19-9, EMA, NSE, AE 1, AE 3, CEA, S-100, glimerius and Bcl-2. These date suggest that the tumor cells produced various tumor markers. In 222 autopsy cases of thymic malignant tumor observed in Japan over a period of 4 years, the dominant pathohistological image was squamous cell carcinoma. It is interesting that the greatest number of combined malignant tumors with thymic malignancies were thyroid papillary carcinomas.

Aged↗
PubMed1975

[A clinico-pathological study on subarachnoid hemorrhage in autopsied cases: the significance of iron containing granule cells seen in autopsied brain with subarachnoid hemorrhage (author's transl)].

Cerebral infarction and petechial hemorrhage are seen in autopsied brains with subarachnoid hemorrhage as most important findings. However, the pathogenesis for the development of these lesions are still obscure. We have been doing clinico-pathological study on the cerebral petechial hemorrhages following subarachnoid hemorrhage. In this report, the findings of these hemorrhagic lesions were presented in detail by means of Perls-Stieda's iron staining. The results are as follows. Cerebral petechial hemorrhages were seen in 3 out of 13 autopsied cases with subarachnoid hemorrhage and almost all hemarrhagic lesions were perivascular. These hemorrhagic lesions were dominantly seen in the regions, thalamus, hypothalamus, midbrain which were close to the accumulated blood clot in the basal cistern, and in the cerebral cortex beneath the accumulated blood clot. Iron containing granular cells were seen not only in the brain surrounding the petechial hemorrhages but also around the vessels which did not show any hemorrhages. On the other hand, it is well known that it needs more than 7 days after hemorrhage in tissue to demonstrate iron containing granular cells by Perls-Stieda' iron staining. So, it might be estimated that the patients survived more than 7 days after the occurance of intracerebral hemorrhages when iron containing granular cells were demonstrated in the autopsied brains. It could be presumed in this study that the petechial hemorrhages following subarachnoid hemorrhage occurred at an early stage of their clinical courses.

Adult↗
PubMed1994

Evolving trends revealed by autopsies of patients with the acquired immunodeficiency syndrome. 565 autopsies in adults with the acquired immunodeficiency syndrome, Los Angeles, Calif, 1982-1993 [corrected].

OBJECTIVE: To determine changes in causes of death, survival, and organ system distribution of major opportunistic infections and neoplasms in adults dying with the acquired immunodeficiency syndrome (AIDS) following the widespread use of antiretroviral therapy and prophylaxis for opportunistic infections since 1988. DESIGN: A retrospective review of autopsy records with gross and microscopic pathologic findings, laboratory data, and clinical histories in cases of AIDS, comparing findings from 1982 through 1988 with those from 1989 through May 1993. SETTING: All autopsies were performed on persons dying in the metropolitan Los Angeles, Calif, area from January 1982 through May 1993. RESULTS: In 565 adult cases of AIDS at autopsy, Pneumocystis carinii pneumonia (PCP) remained the most common cause of death, but both the frequency of and number of deaths of PCP declined over time. Deaths from bacterial sepsis, cytomegalovirus infection, Mycobacterium avium complex infection, and toxoplasmosis also declined during this period, but mortality from fungal infections, tuberculosis, encephalopathy, and causes unrelated to AIDS increased. The death rate from malignant lymphoma remained high. Kaposi's sarcoma (KS) continued to occur more frequently in patients whose risk factor for human immunodeficiency virus infection (HIV) was homosexuality or bisexuality, but the death rate from KS was greatest for patients with a risk factor of blood exposure to HIV. Survival was shorter and deaths from tuberculosis more common in patients with a history of intravenous drug use. Overall survival of patients in other AIDS risk groups increased over time, particularly in those treated with antiretroviral therapy. The organ system distribution of major opportunistic infections and neoplasms was similar throughout the years of the study. The lung was the most frequent organ involved by AIDS-associated diseases leading to death, followed by the gastrointestinal tract and the central nervous system. CONCLUSIONS: The causes of death in AIDS have evolved since 1988 following the widespread use of prophylactic and antiretroviral therapies in patients with HIV infection. This has occurred primarily from changes in overall frequency and death rates from infections. Organ system involvement by AIDS-associated diseases has not changed significantly over time.

AIDS Dementia Complex↗
PubMed2003

Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings.

Because the use of radiology in modern forensic medicine has been, until today, mostly restricted to conventional X-rays, which reduces a 3D body to a 2D projection, a detailed 3D documentation of a gunshot's wound ballistic effects was not possible. The aim of our study was to evaluate whether the progress in imaging techniques over the last years has made it possible to establish an observer-independent and reproducible forensic assessment using multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) technologies for the documentation and analysis of gunshot wounds. The bodies of eight gunshot victims were scanned by MSCT and by MRI; the data of these imaging techniques were post-processed on a workstation, interpreted and subsequently correlated with the findings of classical autopsy. With the spiral CT and MRI examinations and the subsequent 2D multi-planar reformation (MPR) and 3D shaded surface display (SSD) reconstruction, the entire gunshot-created complex skull fractures and brain injuries (such as wound channels and deeply-driven bone splinters) could be documented in complete and graphic detail. CT and MRI also documented vital reaction to the gunshot by demonstrating air emboli in the heart and blood vessels and the classic pattern of blood aspiration to the lung. Gunshot residues deposited within and under the skin were visible. In conclusion, we think that the radiological methods of MSCT and MRI have the potential to become a routine "virtual autopsy" tool in the future. Bullets and relevant histological samples from specific sites then might be won in image-guided minimally invasive fashion via percutaneous biopsy. The rapid application of developing radiological methods may lead to new horizons in forensic documentation and intravital as well as postmortem examination.

Autopsy↗
PubMed1985

Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a 10-year period. Part V. Comparison of autopsy findings with electrocardiograms--Q.QS items of the Minnesota Code.

In a longitudinal study of a general population in Hisayama, Japan, 339 persons aged 40 years or over at death were autopsied during the period November 1, 1961-October 31, 1971. In 308 of these people, electrocardiograms taken at the periodic examinations were available, and Q.QS items of the Minnesota Code were recorded in 49 persons. The sensitivity of item 1-1 to autopsy-proven old myocardial infarction was 0.32 and the specificity was 0.95. Using the estimated prevalence of old myocardial infarction in this community--77 per 100,000--the proportion of persons without old myocardial infarction among those with item 1-1 in the general population (PF+) was 0.9954 and the proportion of persons with old myocardial infarction among those without item 1-1 (PF-) was 0.0005. The sensitivity of items 1-1 and 1-2 to old myocardial infarction was 0.43 and the specificity was 0.94. PF+ of items 1-1 and 1-2 was 0.9949 and PF- was 0.0005. These large values of PF+ mean that more than 99 per cent of persons with these items are probably false positives if these items are used as a screening test for this disease in the general population of this community, i.e., that these items cannot be defined as a definite myocardial infarction.

Aged↗
PubMed1978

Heart autopsy in ischemic heart disease. An autopsy protocol.

The commonly performed autopsy of the heart often fails to demonstrate a satisfactory clinicopathological correlation in cases of death due to ischemic heart disease. An autopsy protocol devised specifically for the study of hearts from patients succumbing to ischemic heart disease is presented. This protocol has been employed in a consecutive series of 63 patients with ischemic heart disease dying at the medical department B, Rigshospitalet in the period 1 September 1975 to 1 May 1976. It comprises a meticulous histological examination of the coronary arteries, including quantitation of luminal narrowing. The ventricular myocardium is sliced transversely, and the Nitro-BT test is applied to identify and delineate acute myocardial infarction, the extent of which is quantitated by pointcounting. In a search for histopathological changes responsible for conducting disturbances, the sinoatrial and the atrioventricular nodes are examined histologically.

Autopsy↗
PubMed1991

The autopsy crisis reexamined: the case for a national autopsy policy.

The use of autopsy in medical practice in the United States has declined drastically over the past 25 years. Physicians conduct post-mortem examinations on less than 12 percent of persons who die in hospitals and on proportionally far fewer people who die at home. Without due assessment of causes of death, pathologists lose opportunities to conduct critical diagnostic exercises, and society fails to obtain accurate health statistics. Medical practitioners, legislators, insurers, and the public should consider diverse features of a national policy for assuring that sufficient numbers of autopsies are competently performed and their findings appropriately employed.

Autopsy↗
PubMed1987

[Extensive active tuberculosis at autopsy: retrospective study of a collection of adult autopsies (1961-1985)].

While over the past decades tuberculous morbidity and mortality have steadily declined in Switzerland, tuberculosis has not been eradicated. The present study investigates tuberculosis in an autopsy material. From 1961 to 1985 severe active tuberculosis was seen in 1.9% of autopsies performed; pulmonary tuberculosis accounted for 54% and miliary tuberculosis 35.3%. The majority of cases of severe active tuberculosis were seen in the elderly. Clinically undiagnosed cases made up 44% of the cases. A constant decrease in severe active tuberculosis has been seen over the years, but clinically undiagnosed cases are on the increase.

Adult↗
PubMed1984

Autopsy findings in postoperative acute renal failure patients, collected from the annuals of pathological autopsy cases in Japan.

Autopsy findings in post-surgical acute renal failure cases were studied in 131 cases on diaysis collected from annuals of pathological Autopsy Cases in Japan (1958-1981). Fifty (38.2%) abdominal and 48 (36.6%) cardiovascular operative procedures were the origins of the 131 post-operative acute renal failure patients treated by dialysis. The incidence of acute tubular necrosis was 68.7 per cent. There were 13 non-obstetric cases (19.9%) of acute bilateral cortical necrosis. Direct causes of death in postsurgical acute renal failure patients were mainly infection (61.7%) and bleeding (21.0%) The incidence of patients with infectious disease complicating postsurgical acute renal failure was 60.3 per cent and the rate of those between 20 and 70 years of age was constant. The incidence of patients with bleeding was 45.0 per cent and no significant differences were seen in the 20-70 year age range.

Acute Kidney Injury↗
PubMed1984

Autopsy findings in diabetic nephropathy patients under dialysis, collected from the annuals of pathological autopsy cases in Japan.

Collected from the Annuals of Pathological Autopsy Cases in Japan (1958-1980), autopsy findings of diabetic patients under dialysis were studied in 103 cases on peritoneal dialysis and 103 cases on hemodialysis. Direct causes of death in 13 cases (12.6%) of the 103 diabetic patients on peritoneal dialysis and in 8 cases (7.8%) of the 103 diabetic patients on hemodialysis was infections, and in seven cases (6.8%) on peritoneal dialysis and 19 cases (18.4%) on hemodialysis was bleeding. The incidence of bleeding in diabetic patients on hemodialysis was significantly higher than that in peritoneal dialysis cases (p less than 0.025). Other direct causes of death in diabetic patients on dialysis included myocardial infarction, uremia, pulmonary edema, liver cirrhosis and carcinoma. No significant difference was seen between peritoneal dialysis and hemodialysis, except the incidence of complications of bleeding and pericarditis.

Adult↗