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PubMed2002

Maintaining a glycerolized skin bank--a practical approach.

The Helsinki Burn Unit admits around 120-140 patients a year and, of these, 20-30 need intensive care. Before 1995, fresh, non-tested cadaver skin was used to cover widely meshed autografts in large burns. In 1995, we founded a skin bank to avoid the problems encountered in the use of fresh cadaver skin: contamination by viruses or bacteria, shortage of available skin, the occasionally poor quality of the cadaver skin, and the inconvenience of harvesting skin in the mortuary. Crucial to the work of the Skin Bank has been cooperation with the Transplantation Unit of our hospital. This reduces paperwork and guarantees the quality of the donors. It also enables us to harvest skin only from tested multiorgan donors in an operating theater setting. Also important is a well organized team to ensure the procurement of a sufficient amount of good-quality allografts. This requirement raises the otherwise low costs of a glycerolized skin bank.

Burns↗
PubMed1996

The 'high-risk' neuropathological autopsy in AIDS and Creutzfeldt-Jakob disease: principles and practice.

There is much current clinical, pathological and scientific interest in infective disorders of the central nervous system, particularly those associated with the human immunodeficiency virus (AIDS) and the transmissible human spongiform encephalopathies (Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome and fatal familial insomnia). To investigate these disorders it is necessary to develop and follow procedures for performing autopsies on known or suspected cases which allow both diagnostic and research investigations to be carried out, while at the same time presenting minimal risk to pathologists, mortuary and laboratory technical staff. This article reviews the objectives for performing 'high-risk' autopsies, and summarizes current guidelines for autopsy procedures and laboratory tissue handling in light of extensive experience in the Neuropathology Laboratory, University of Edinburgh. Neuropathology has a leading role to play in diagnosis and research in this important field; the need for 'high-risk' autopsies is likely to increase into the next century.

Acquired Immunodeficiency Syndrome↗
PubMed1997

A survey of general practitioners' views on autopsy reports.

AIMS: To study the views of general practitioners on the quality and utility of autopsy reports, and on autopsies in general. METHODS: For a period of six months, a questionnaire was enclosed with each autopsy report sent to a general practitioner from the mortuary at Manchester Royal Infirmary. RESULTS: Most (93.3%) general practitioners found the autopsy report useful, and many (66.7%) thought the bereaved relatives would do so too. However, only a minority (25.2%) would discuss the report with the relatives. A considerable proportion (20.0%) found the cause of death surprising, and a significant number (10.4%) felt the report would modify their future clinical practice. There was approval of autopsies in general, with most (88.6%) agreeing that autopsies reveal lesions not detected in life, and many (74.4%) indicating that loss of the autopsy would impair severely the monitoring of clinical standards. CONCLUSIONS: General practitioners appreciate autopsy reports, which may have a significant impact on clinical practice. Autopsy reports provide both case audit and information for relatives.

Adult↗
PubMed1988

Renal weights in the southern African black population.

Renal weights of 430 adult black subjects coming to medicolegal autopsy at the Diepkloof State Mortuary, a large urban area southwest of Johannesburg, South Africa, were analyzed. The subjects were from 10 southern African black ethnic groups-Zulu, Sotho, Tswana, Xhosa, Shangaan, Swazi, Venda, Ndebele, Kalanga, and Malawi. The aims of the study were: 1) to ascertain the anatomical "norm" as it pertains to renal weights in this diverse population group; 2) to formulate standard reference tables that might be of use to the practicing pathologist in the southern African arena; 3) to provide a range of values that take into account the variables of age, sex, race, body weight, and body height; and 4) to provide a standard of comparison with anthropological and anatomical studies conducted on North American black, North American Caucasian, Indian subcontinent, Burmese, and Jamaican population groups. In each of the 430 subjects, age, sex, ethnic group, supine body length, body weight, individual left and right renal weights, and causes of death were noted. The latter were divided into 6 categories: 1) penetrating incised wounds; 2) multiple injuries; 3) gunshot wounds; 4) craniocerebral injuries; 5) various miscellaneous nonnatural causes of death; and 6) natural causes of death. The above variables were analyzed by computer and compared with respect to renal weights. No statistically significant differences were observed between the sexes or the age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The law and the certification, verification and registration of death.

Daisy was a registered nurse who worked in a community hospital. One night, Gwen, who was 85 years old, died and Daisy phoned the GP who was responsible for providing a service to the hospital. She was told that the GP did not come out at night for a death but would come in the morning. Daisy wanted the patient moved from the four-bedded ward to the mortuary, but was told that the procedures did not permit that until a doctor had certified the death. Daisy felt that it was unsettling to the other patients who knew that Gwen had died. What is the law?

Aged↗
PubMed2005

The story of the body and the story of the person: towards an ethics of representing human bodies and body-parts.

Western culture has a few traditions of representing the human body - among them mortuary art (gisants), the freak show, the culture of the relics, renaissance art and pre-modern and modern anatomy. A historical analysis in the spirit of Norbert Elias is offered with regard to body - person relationship in anatomy. Modern anatomy is characterized by separating the story of the person from the story of the body, a strategy that is incompatible with the bio-psycho-social paradigm of clinical medicine. The paper discusses different aspects of the above traditions and how they might bear on this conflict and on contemporary bioethics and bedside practice.

Anatomy, Artistic↗
PubMed1998

Consuming the dead: a Kleinian perspective on death rituals cross-culturally.

The author argues that Melanie Klein's theories of mourning shed light on certain funerary practices encountered widely in ethnographic literature, namely 'second burial'. Pointing out that the death of a loved person is experienced in fantasy as the destruction of the internalised mother imago, the author shows how various Kleinian processes involved in infantile fears of maternal loss--such as persecutory anxiety, guilt, depression, and attempts at reparation--are clearly expressed in rituals of mourning cross-culturally. The argument is illustrated with two extensive case studies, Bali (Indonesia) and the Mekeo of coastal Papua New Guinea. A number of other cultures are considered briefly to indicate the relevance of Kleinian theory to the symbolism of death rituals more broadly, including the role played by sorcery and witchcraft beliefs, fears of malevolent ghosts, repeated re-burial, mortuary gift exchange, cremation, mortuary cannibalism, and the denial of death in modern western funeral rites.

Attitude to Death↗
PubMed2004

Medical examiners, coroners, and biologic terrorism: a guidebook for surveillance and case management.

Medical examiners and coroners (ME/Cs) are essential public health partners for terrorism preparedness and response. These medicolegal investigators support both public health and public safety functions and investigate deaths that are sudden, suspicious, violent, unattended, and unexplained. Medicolegal autopsies are essential for making organism-specific diagnoses in deaths caused by biologic terrorism. This report has been created to 1) help public health officials understand the role of ME/Cs in biologic terrorism surveillance and response efforts and 2) provide ME/Cs with the detailed information required to build capacity for biologic terrorism preparedness in a public health context. This report provides background information regarding biologic terrorism, possible biologic agents, and the consequent clinicopathologic diseases, autopsy procedures, and diagnostic tests as well as a description of biosafety risks and standards for autopsy precautions. ME/Cs' vital role in terrorism surveillance requires consistent standards for collecting, analyzing, and disseminating data. Familiarity with the operational, jurisdictional, and evidentiary concerns involving biologic terrorism-related death investigation is critical to both ME/Cs and public health authorities. Managing terrorism-associated fatalities can be expensive and can overwhelm the existing capacity of ME/Cs. This report describes federal resources for funding and reimbursement for ME/C preparedness and response activities and the limited support capacity of the federal Disaster Mortuary Operational Response Team. Standards for communication are critical in responding to any emergency situation. This report, which is a joint collaboration between CDC and the National Association of Medical Examiners (NAME), describes the relationship between ME/Cs and public health departments, emergency management agencies, emergency operations centers, and the Incident Command System.

Bioterrorism↗
PubMed1997

O6-alkylguanine DNA alkyltransferase activity in student embalmers.

O6-Alkylguanine-DNA alkyltransferase (AGT) activity was assessed in peripheral blood lymphocytes among 23 mortuary science students before and after 9 weeks in a laboratory course in techniques of embalming. Formaldehyde exposure was established by environmental monitoring. The average air concentration of formaldehyde during embalming was about 1.5 ppm. At the pre-exposure sampling, baseline DNA repair capacity tended to be reduced in subjects who reported a prior history of embalming (p = 0.08). From pre- to post-exposure, 17 subjects decreased in DNA repair capacity, while only 6 increased (p < 0.05). Analysis of variance, including adjustment for age, sex, and smoking status, confirmed these findings. Among the eight subjects who had no embalming experience during the 90 days before study, seven had decreased and one had increased AGT activity during the period of study (p < 0.05). For those with prior embalming experience, 10 subjects decreased in AGT activity, while 5 increased (p < 0.05). Although the major chemical exposure in embalming practice was to formaldehyde, no clear link was established between amount of formaldehyde exposure and AGT activity.

Adult↗
PubMed1996

AIDS and professional secrecy in the United States.

OBJECTIVE: To create a legal awareness of AIDS patients' right to privacy among the medical profession. DISCUSSION AND RECOMMENDATIONS: Doctors should recognize confidentiality as a patient's right, since in most countries the AIDS patient is practically considered a person who is going through a punishment, having no legal rights, rather than a patient suffering from a grave illness. Originally the common law did not recognize the concept of professional secrecy as a right of the patient. It was only regarded as an ethical duty not actionable in court. But with the eruption of diseases such as AIDS, statutes requiring written authorization for the release of confidential information were enacted. A problem with our hospital records is that they are freely available to almost all the staff in the hospitals and sometimes even to outsiders. In the case of AIDS at least, strict measures should be taken to enforce secrecy in relation to all disease-related information such as sexual history, HIV status and CD4 cell counts. The duty to keep medical information confidential is not absolute. An overriding duty towards society, occurs when the benefits of disclosure outweigh its harm. This utopian argument is even more convincing when an HIV-positive person is acting irresponsibly, engaging in risky behaviour without warning the partner. All persons who have a compelling interest, such as sexual partners, needle sharers, medical and nursing personnel, should be provided with this information. It should also extend to mortuary attendants when the patient dies. A person having a STD has a legal duty to take precautions against transmission. In Berner v. Caldwell (543 So. 2d. 686), the US court held that one who knows or should reasonably know that he has genital herpes is under a duty to abstain from sex or warn others before risky contact. As doctors we should familiarize ourselves now with the concepts and laws regarding patients' rights, without waiting until a malpractice crisis develops to correct ourselves.

Confidentiality↗
PubMed2002

Lethal outbreak of infection with Clostridium novyi type A and other spore-forming organisms in Scottish injecting drug users.

This report describes the investigation and management of an unprecedented outbreak of severe illness among injecting drug users (IDUs) in Scotland during April to August 2000. IDUs with severe soft tissue inflammation were prospectively sought among acute hospitals and a mortuary in Scotland. Cases were categorised as definite or probable: probable cases had severe injection site inflammation or multi-system failure; definite cases had both. Information about clinical course, mortality, post-mortem findings and laboratory data was gathered by standardised case-note review and interview. Sixty cases were identified--23 definite and 37 probable. Most had familial or social links with each other and 50 were from Glasgow. Median age was 30 years; 31 were female. The majority, especially definite cases, injected heroin/citric acid extravascularly. Of definite cases, 20 died (87% case-fatality rate; 13 after intensive care), 15 had necrotising fasciitis, 22 had injection site oedema and 13 had pleural effusion. Median white cell count was 60 x 10(9)/L. Of 37 probable cases, three died (8% case-fatality rate). Overall, the most frequently isolated pathogen was Clostridium novyi type A (13 cases: 8 in definite cases). The findings are consistent with an infection resulting from injection into soft tissue of acidified heroin contaminated with spore-forming bacteria. Toxin production led to a severe local reaction and, in many, multi-system failure.

Adult↗