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Feola A, Ciamarra P, Cavezza A, Carfora A, Campobasso CP. Choking in patients with neurological disorders and role of drug-induced dysphagia. Leg Med (Tokyo) 2024; 69:102339. [PMID: 37872072 DOI: 10.1016/j.legalmed.2023.102339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
Choking is a type of asphyxia due to the internal obstruction of airways by foreign material, quite always food. Most choking deaths are accidental and occur so quickly that may mimic a heart attack. This scenario is also known as "Cafè coronary syndrome" or "bolus death". At autopsy, pieces of under-chewed food are commonly lodged at, above, or in the tracheal space adjacent to the laryngeal inlet. In these fatal events mechanisms other than asphyxia can be also involved, such as a vasovagal episode (by stimulation of the autonomic nerve plexus of the laryngeal inlet) or swallowing impairment. Swallowing is a complex, semi-automatic process that can be affected by various disorders (i.e. dementia, Parkinson, neurological injuries, etc.), senility and external factors causing oropharyngeal dysphagia (OD). Among these factors, several drugs have been also associated with impaired swallowing, including drugs acting on the CNS like antipsychotics and antiepileptics. Three cases of witnessed bolus deaths are reported. All victims were affected by neurological defects and took medications acting on CNS. In all cases, at autopsy pieces of food were found distributed from the laryngeal inlet along the main axis of the trachea up to the large bronchi over the bifurcation. Additional autopsy findings were represented by facial congestion and cyanosis, subepicardial petechiae and pulmonary emphysema.
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Affiliation(s)
- Alessandro Feola
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, 80138 Naples, Italy
| | - Paola Ciamarra
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, 80138 Naples, Italy.
| | - Antonio Cavezza
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, 80138 Naples, Italy
| | - Anna Carfora
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, 80138 Naples, Italy
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, 80138 Naples, Italy
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AlGheryafi ZF, Alnasser FF, Almukhtar FH, Aldajani FA, Al Qassim FH, Al Zakaria ZM, Alshammari SO, Menezes RG. Differentiating suicide from homicide in sharp-force fatalities with stab and/or incised wounds: A scoping review. Leg Med (Tokyo) 2024; 67:102388. [PMID: 38219705 DOI: 10.1016/j.legalmed.2023.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
The majority of sharp-force fatalities with stab and/or incised wounds are homicides. However, suicidal sharp-force fatalities with stab and/or incised wounds are also reported. Thus, distinguishing suicidal stab and/or incised wounds from homicidal stab and/or incised wounds is significant from the forensic perspective. This scoping review primarily summarizes the existing research findings on the differentiation of suicide from homicide in sharp-force fatalities with stab and/or incised wounds. The literature was systematically searched on February 28, 2023, using the PubMed database. A search string formed by a combination of keywords related to suicide, homicide, and stab and incised wounds yielded 23 records. After applying the eligibility criteria, six records/studies met the inclusion criteria and were included in the present scoping review. Results showed that the predictive strength of various parameters, either individually or collectively, in diagnosing the manner of sharp-force fatality as suicide or homicide is not always hundred percent accurate. Some of the important predictors of the homicidal manner of death in sharp-force fatalities include clothing damage, presence of defense injuries, presence of injuries caused by another type of violence other than sharp-force, vertically oriented chest stabs, and sharp-force injuries in the head and back anatomical sites. Some of the important predictors of the suicidal manner of death in sharp-force fatalities include the presence of tentative injuries, sharp-force injuries to the wrist, and the presence of a suicide note.
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Affiliation(s)
- Zainab Fathi AlGheryafi
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatima Foud Alnasser
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatima Hussain Almukhtar
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatema Abdullatef Aldajani
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Hussain Al Qassim
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zainab Mohammed Al Zakaria
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shoq Obeid Alshammari
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ritesh G Menezes
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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Callegari E, Agnolucci J, Angiola F, Fais P, Giorgetti A, Giraudo C, Viel G, Cecchetto G. The Precision, Inter-Rater Reliability, and Accuracy of a Handheld Scanner Equipped with a Light Detection and Ranging Sensor in Measuring Parts of the Body-A Preliminary Validation Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:500. [PMID: 38257593 PMCID: PMC10820714 DOI: 10.3390/s24020500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Anthropometric measurements play a crucial role in medico-legal practices. Actually, several scanning technologies are employed in post-mortem investigations for forensic anthropological measurements. This study aims to evaluate the precision, inter-rater reliability, and accuracy of a handheld scanner in measuring various body parts. METHODS Three independent raters measured seven longitudinal distances using an iPad Pro equipped with a LiDAR sensor and specific software. These measurements were statistically compared to manual measurements conducted by an operator using a laser level and a meterstick (considered the gold standard). RESULTS The Friedman test revealed minimal intra-rater variability in digital measurements. Inter-rater variability analysis yielded an ICC = 1, signifying high agreement among the three independent raters. Additionally, the accuracy of digital measurements displayed errors below 1.5%. CONCLUSIONS Preliminary findings demonstrate that the pairing of LiDAR technology with the Polycam app (ver. 3.2.11) and subsequent digital measurements with the MeshLab software (ver. 2022.02) exhibits high precision, inter-rater agreement, and accuracy. Handheld scanners show potential in forensic anthropology due to their simplicity, affordability, and portability. However, further validation studies under real-world conditions are essential to establish the reliability and effectiveness of handheld scanners in medico-legal settings.
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Affiliation(s)
- Enrica Callegari
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Jacopo Agnolucci
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Francesco Angiola
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Paolo Fais
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (P.F.); (A.G.)
| | - Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (P.F.); (A.G.)
| | - Chiara Giraudo
- Unit of Radiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35100 Padova, Italy;
| | - Guido Viel
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Giovanni Cecchetto
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
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Montisci R, Licciardi M, Cecchi R, Kondo T, Gerosa G, Casula R, Cecchetto G, Montisci M. Malpratice claims in cardiology and cardiac surgery: A medico-legal issue. Leg Med (Tokyo) 2023; 65:102319. [PMID: 37696211 DOI: 10.1016/j.legalmed.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Medical liability has become a challenge in every physician's modern practice with the consequent loss of the physician's autonomy and an increase in "defensive medicine". From this perspective, the role of Legal Medicine in assessing medical liability has become increasingly specific and a homogenization of the methods of ascertainment is increasingly necessary, since such a process can contribute to strengthening the guarantees in professional liability procedures. Focusing on malpractice claims in the field of cardiology, the complexity of the management of cardiac pathologies and the frequency of severe adverse events implies the importance of a multi-disciplinary approach, together with the application of a shared ascertainment methodology. In particular, it is essential for the forensic pathologist to collaborate with experts in cardio-pathology, cardiology and/or cardiac surgery in cases of alleged medical liability in the cardiologic field and to follow the guidelines which have been produced to assist the expert dealing with deaths reflecting cardiac disease, in order to prevent criticism of case analysis in medico-legal environments and to promote the standardization of the structure of the juridical-legislative medical malpractice lawsuits.
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Affiliation(s)
- R Montisci
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Licciardi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - R Cecchi
- Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy.
| | - T Kondo
- Institute of Legal Medicine, Wakayama Medical University School of Medicine Graduate School of Medicine, Japan
| | - G Gerosa
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - R Casula
- Clinical Cardiology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - G Cecchetto
- Legal Medicine and Toxicology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Montisci
- Legal Medicine and Toxicology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Sacco MA, Gualtieri S, Calanna L, Ricci P, Aquila I. Exploring the Potential of Proteome Analysis as a Promising Tool for Evaluation of Sudden Cardiac Death (SCD) in Forensic Settings: A Literature Review. Int J Mol Sci 2023; 24:14351. [PMID: 37762655 PMCID: PMC10531952 DOI: 10.3390/ijms241814351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Sudden cardiac death (SCD) represents a global emergency, with a high number of cases affecting all age groups every year. The prevention of these fatal events requires an accurate knowledge of etiology and pathogenesis, which can vary. Autopsy is an indispensable tool in cases of SCD for diagnostic purposes, as well as for judicial and preventive purposes for family members. Despite the completion of all routine post-mortem investigations, it is often complicated for the forensic pathologist to define the triggering cause of these events. The study of the proteome is proving to be extremely promising in the field of human cardiovascular disease. This paper aims to offer a literature review on the study of the proteome in post-mortem cadaveric biological samples obtained from SCD cases. The aim of this work is to outline the state of the art of the scientific advances that protein analysis can offer in the diagnosis of SCD and the limits that various studies have traced up to now. In conclusion, the work defines the future perspectives of this field in SCD, suggesting strategies to overcome the reported limits and improve the diagnostics of these events.
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Affiliation(s)
| | | | | | | | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (L.C.); (P.R.)
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Mantilla MJ, Chaves JJ, Santacruz JC, Rodríguez-Salas G, Rueda I, Santos AM, Londoño J, Mantilla JC. Causes of death in patients with autoimmune and rheumatic diseases-a 16-year autopsy-based study. Autops Case Rep 2023; 13:e2023430. [PMID: 37287565 PMCID: PMC10243749 DOI: 10.4322/acr.2023.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 06/09/2023]
Abstract
Introduction the autopsy is an essential medical procedure; however, its use has declined over the decades. In autoimmune and rheumatological diseases, anatomical and microscopic diagnosis is critical to diagnose of the cause of death. For this reason, our objective is to describe the cause of death in patients diagnosed with autoimmune and rheumatic diseases who underwent an autopsy in a Pathology reference center in Colombia. Materials and methods a retrospective and descriptive study of autopsy reports. Results between January 2004 and December 2019, 47 autopsies of patients with autoimmune and rheumatological diseases were performed. Systemic lupus erythematosus and rheumatoid arthritis were the most common diseases. The leading cause of death was related to infections, being opportunistic infections in the majority of the cases. Conclusions our autopsy-based study was focused on patients with autoimmune and rheumatological conditions. Infections are the leading cause of death, particularly opportunistic infections, diagnosed mainly by microscopy. Thus, the autopsy should continue to be considered the "gold standard" to determine the cause of death in this population.
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Affiliation(s)
| | - Juan José Chaves
- Fundación Universitaria de Ciencias de la Salud, Departamento de Patología, Bogotá, Colombia
| | | | | | - Igor Rueda
- Universidad de La Sabana, Departamento de Reumatología, Chía, Colombia
| | - Ana Maria Santos
- Universidad de La Sabana, Departamento de Reumatología, Chía, Colombia
| | - John Londoño
- Universidad de La Sabana, Departamento de Reumatología, Chía, Colombia
| | - Julio Cesar Mantilla
- Universidad Industrial de Santander, Departamento de Patología, Bucaramanga, Colombia
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Cecchetto G, De Leo D, Pancheri A, Franchetti G, Proto S, Cocchio S, Furlan P, Corlianò P, Baldo V, Viel G, Feltrin G. Organ procurement requiring the authorization of the judicial authority. An epidemiological investigation in the Veneto region (Italy). Leg Med (Tokyo) 2023; 61:102218. [PMID: 36796174 DOI: 10.1016/j.legalmed.2023.102218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND When death occurs through a mechanism requiring a forensic investigation, consent for organ harvesting must be sought from the Judicial Authority (JA). AIM To perform a retrospective study of potential organ donors in the Veneto region over a six-year period (2012-2017), analysing any differences between cases in which the JA approved or denied organ harvesting. MATERIAL AND METHODS Both non-heart beating (NHB) and heart beating (HB) donors were included. For HB cases, personal and clinical data were collected. To evaluate the correlation between the JA response and the circumstantial and clinical data a logistic multivariate analysis was performed, estimating the adjusted odds ratios (adjORs). RESULTS Between 2012 and 2017, 17,662 organ and/or tissue donors were included, of which 16,418 were NHB donors and 1,244 HB-donors. Among the 1,244 HB-donors, JA authorization was asked in 200 cases (16.1%), approved in 154 cases (77.0%), limited in 7 cases (3.5%) and denied in 39 cases (19.5%). The JA denied the authorization for organ harvesting in 53,3% of cases with hospitalizations of less than 1 day and in 9,4% of cases with hospitalization exceeding one week [adjOR(95%CI) = 10.67 (1.92-59.22)]. The performance of an autopsy was linked to a higher chance of denied outcome from the JA [adjOR(95%CI): 3.45 (1.42-8.39)]. CONCLUSIONS Improvements in the communication between organ procurement organizations and the JA through efficient protocols furnishing detailed information on the cause of death might lead to a better procurement process with an increase in the number of transplanted organs.
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Affiliation(s)
- Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy.
| | - Domenico De Leo
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Anna Pancheri
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Giorgia Franchetti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Sara Proto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Patrizia Furlan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Pantaleo Corlianò
- Regional Centre for Transplant Coordination of Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Giuseppe Feltrin
- Regional Centre for Transplant Coordination of Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
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Franchetti G, Viel G, Fais P, Fichera G, Cecchin D, Cecchetto G, Giraudo C. Forensic applications of micro-computed tomography: a systematic review. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose
The aim of this systematic review was to provide a comprehensive overview of micro-CT current applications in forensic pathology, anthropology, odontology, and neonatology.
Methods
A bibliographic research on the electronic databases Pubmed and Scopus was conducted in the time frame 01/01/2001–31/12/2021 without any language restrictions and applying the following free-text search strategy: “(micro-computed tomography OR micro-CT) AND (forensic OR legal)”. The following inclusion criteria were used: (A) English language; (B) Application of micro-CT to biological and/or non-biological materials to address at least one forensic issue (e.g., age estimation, identification of post-mortem interval). The papers selected by three independent investigators have been then classified according to the investigated materials.
Results
The bibliographic search provided 651 records, duplicates excluded. After screening for title and/or abstracts, according to criteria A and B, 157 full-text papers were evaluated for eligibility. Ninety-three papers, mostly (64) published between 2017 and 2021, were included; considering that two papers investigated several materials, an overall amount of 99 classifiable items was counted when referring to the materials investigated. It emerged that bones and cartilages (54.55%), followed by teeth (13.13%), were the most frequently analyzed materials. Moreover, micro-CT allowed the collection of structural, qualitative and/or quantitative information also for soft tissues, fetuses, insects, and foreign materials.
Conclusion
Forensic applications of micro-CT progressively increased in the last 5 years with very promising results. According to this evidence, we might expect in the near future a shift of its use from research purposes to clinical forensic cases.
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Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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10
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Historical Advancements and Evolution in Understanding Human Anatomy and Pathology: The Contribution of the Middle Ages. Adv Anat Pathol 2021; 28:171-177. [PMID: 33825719 DOI: 10.1097/pap.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dissections and autopsies are critical for understanding human anatomy, pathology, and uncovering mechanisms of disease. This review presents an historical journey from ancient times until the late Middle Ages. The major steps and developments are summarized with key figures and events presented.
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Giorgetti A, Pascali J, Montisci M, Amico I, Bonvicini B, Fais P, Viero A, Giorgetti R, Cecchetto G, Viel G. The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis. Metabolites 2021; 11:metabo11030189. [PMID: 33810163 PMCID: PMC8004630 DOI: 10.3390/metabo11030189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Methadone-related deaths are characterized by a wide range of post-mortem blood concentrations, due to the high pharmacokinetic/dynamic inter-individual variability, the potential subjective tolerance state and to other risk factors or comorbidities, which might enhance methadone acute toxicity. In the present study, the association among pre-existing and external conditions and diseases and the resultant methadone death capacity have been investigated. Beside a systematic literature review, a retrospective case-control study was done, dividing cases in which methadone was the only cause of death (controls), and those with associated clinical-circumstantial (naive/non-tolerant state), pathological (pulmonary or cardiovascular diseases) or toxicological (other drugs detected) conditions. Methadone concentrations were compared between the two groups and the association with conditions/diseases was assessed by multiple linear and binomial logistic regressions. Literature cases were 139, in house 35, consisting of 22 controls and 152 cases with associated conditions/diseases. Mean methadone concentrations were 2122 ng/mL and 715 ng/mL in controls and cases respectively, with a statistically significant difference (p < 0.05). Lower methadone concentrations (by 24, 19 and 33% respectively) were detected in association with naive/non-tolerant state, pulmonary diseases and presence of other drugs, and low levels of methadone (<600 ng/mL) might lead to death in the presence of the above conditions/diseases.
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Affiliation(s)
- Arianna Giorgetti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.G.); (P.F.)
| | - Jennifer Pascali
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Massimo Montisci
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Irene Amico
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Barbara Bonvicini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Paolo Fais
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.G.); (P.F.)
| | - Alessia Viero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, via Conca 71, 60126 Ancona, Italy;
| | - Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
- Correspondence:
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12
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Robb TJ, Tse R, Blenkiron C. Reviving the Autopsy for Modern Cancer Evolution Research. Cancers (Basel) 2021; 13:409. [PMID: 33499137 PMCID: PMC7866143 DOI: 10.3390/cancers13030409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
Outstanding questions plaguing oncologists, centred around tumour evolution and heterogeneity, include the development of treatment resistance, immune evasion, and optimal drug targeting strategies. Such questions are difficult to study in limited cancer tissues collected during a patient's routine clinical care, and may be better investigated in the breadth of cancer tissues that may be permissible to collect during autopsies. We are starting to better understand key tumour evolution challenges based on advances facilitated by autopsy studies completed to date. This review article explores the great progress in understanding that cancer tissues collected at autopsy have already enabled, including the shared origin of metastatic cells, the importance of early whole-genome doubling events for amplifying genes needed for tumour survival, and the creation of a wealth of tissue resources powered to answer future questions, including patient-derived xenografts, cell lines, and a wide range of banked tissues. We also highlight the future role of these programmes in advancing our understanding of cancer evolution. The research autopsy provides a special opportunity for cancer patients to give the ultimate gift-to selflessly donate their tissues towards better cancer care.
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Affiliation(s)
- Tamsin Joy Robb
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1051, New Zealand;
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1051, New Zealand;
| | - Cherie Blenkiron
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1051, New Zealand;
- Auckland Cancer Society Research Centre, University of Auckland, Auckland 1051, New Zealand
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13
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CARASCAL MARKB, FONTANILLA IANKENDRICHC, DE UNGRIA MARIACORAZONA. The Ibaloi fire mummies: the art and science of mummification in the Philippines. ANTHROPOL SCI 2021. [DOI: 10.1537/ase.210422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- MARK B. CARASCAL
- Institute of Biology, University of the Philippines, Diliman Quezon City
| | | | - MARIA CORAZON A. DE UNGRIA
- DNA Analysis Laboratory, Natural Sciences Research Institute, University of the Philippines, Diliman, Quezon City
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De Simone S, Maglietta F, Ferrara M, Spagnolo L, Ricci P, De Carlo D, Salerno M, Sessa F, Bertozzi G. Homicide or car accident: The case of the 'guilty' fibre. Med Leg J 2019; 87:77-80. [PMID: 30955448 DOI: 10.1177/0025817219830275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crime scene investigation should be carried out using a critical forensic approach by an expert team. This provides essential tools in the research and collection of evidence and samples which must be integrated with the autopsy and the police officers' investigations. This paper aims to highlight the importance of a multidisciplinary approach to crime scene investigation and describes a very interesting criminal case. As demonstrated by this case, the evidence obtained from the crime scene analysis sheds light on difficult cases, such as murders staged as suicides or accidents.
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Affiliation(s)
- Stefania De Simone
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Francesca Maglietta
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Michela Ferrara
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Lorenzo Spagnolo
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Pietrantonio Ricci
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy.,2 Institute of Legal Medicine, Universita degli studi Magna Graecia di Catanzaro, Catanzaro, Italy
| | - Dania De Carlo
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Monica Salerno
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Francesco Sessa
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Bertozzi
- 1 Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
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15
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State of the art in post-mortem computed tomography: a review of current literature. Virchows Arch 2019; 475:139-150. [PMID: 30937612 DOI: 10.1007/s00428-019-02562-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/06/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
Computed tomography (CT) and other advanced diagnostic imaging techniques are gaining popularity in forensic pathology. This paper aims to define and offer complete and easily accessible "state of the art" for post-mortem computed tomography (PMCT), by reviewing the latest international literature. The proposed format answers the "five Ws" that follows: (1) What: We report the different kinds of CT scan and settings generally used in post-mortem imaging. The machine most employed is a 8/16-slice spiral CT, usually without contrast enhancement. The introduction of some variables, such as CT-guided biopsies, post-mortem ventilation, and PMCT angiography is becoming increasingly useful. (2) Why: Literature highlights the many advantages of PMCT. Limitations can be partly overcome by modern imaging techniques and combined evaluation with traditional autopsy. (3) Who: Most authors agree that collaboration between different specialists, i.e., radiologists and pathologists, is the best scenario, since radiologic, anatomic, and forensic skills are needed simultaneously. The most important human factor is "teamwork". (4) When: Literature provides no absolute limits for performing PMCT. Some authors have tested PMCT as a replacement for conventional autopsy but found some limitations. Others evaluated PMCT as a guide or screening tool for traditional autopsy. (5) Where: Many research groups around the world have performed studies on the use of PMCT. Although few countries adopt PMCT in routine practice, its use is rapidly spreading.
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Buja LM, Barth RF, Krueger GR, Brodsky SV, Hunter RL. The Importance of the Autopsy in Medicine: Perspectives of Pathology Colleagues. Acad Pathol 2019; 6:2374289519834041. [PMID: 30886893 PMCID: PMC6410379 DOI: 10.1177/2374289519834041] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/17/2022] Open
Abstract
This article presents a perspective on the importance of the autopsy in medical practice and science based on experiences of the authors as physician-scientists involved in autopsy practice. Our perspectives are presented on the seminal contributions of the autopsy in the areas of cardiovascular disease, including congenital heart disease, atherosclerosis, coronary artery disease, and myocardial infarction, and infectious disease, including tuberculosis and viral infections. On the positive side of the future of the autopsy, we discuss the tremendous opportunities for important research to be done by application of advanced molecular biological techniques to formalin-fixed, paraffin-embedded tissue blocks obtained at autopsy. We also note with concern the countervailing forces impacting the influence of pathology in education and clinical practice at our academic medical centers, which also present impediments to increasing autopsy rates. Our challenge as academic pathologists, whose careers have been molded by involvement in the autopsy, is to counter these trends. The challenges are great but the benefits for medicine and society are enormous.
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Affiliation(s)
- Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Rolf F. Barth
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Gerhard R. Krueger
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Sergey V. Brodsky
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Robert L. Hunter
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Fernandes F, Castillo P, Bassat Q, Quintó L, Hurtado JC, Martínez MJ, Lovane L, Jordao D, Bene R, Nhampossa T, Ritchie PS, Bandeira S, Sambo C, Chicamba V, Mocumbi S, Jaze Z, Mabota F, Ismail MR, Lorenzoni C, Sanz A, Rakislova N, Marimon L, Cossa A, Mandomando I, Vila J, Maixenchs M, Munguambe K, Macete E, Alonso P, Menéndez C, Ordi J, Carrilho C. Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy. Hum Pathol 2018; 85:184-193. [PMID: 30496801 PMCID: PMC6478426 DOI: 10.1016/j.humpath.2018.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/02/2022]
Abstract
Although autopsy diagnosis includes routinely, a thorough evaluation of all available pathological results and also of any available clinical data, the contribution of this clinical information to the diagnostic yield of the autopsy has not been analyzed. We aimed to determine to which degree the use of clinical data improves the diagnostic accuracy of the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), a simplified pathological postmortem procedure designed for low-income sites. A total of 264 coupled MIA and CDA procedures (112 adults, 57 maternal deaths, 54 children, and 41 neonates) were performed at the Maputo Hospital, Mozambique. We compared the diagnoses obtained by the MIA blind to clinical data (MIAb), the MIA adding the clinical information (MIAc), and the CDA blind to clinical information (CDAb), with the results of the gold standard, the CDA with clinical data, by comparing the International Classification of Diseases, Tenth Revision codes and the main diagnostic classes obtained with each evaluation strategy (MIAb, MIAc, CDAb, CDAc). The clinical data increased diagnostic coincidence to the MIAb with the gold standard in 30 (11%) of 264 cases and modified the CDAb diagnosis in 20 (8%) of 264 cases. The increase in concordance between MIAb and MIAc with the gold standard was significant in neonatal deaths (κ increasing from 0.404 to 0.618, P = .0271), adult deaths (κ increasing from 0.732 to 0.813, P = .0221), and maternal deaths (κ increasing from 0.485 to 0.836, 0.;P < .0001). In conclusion, the use of clinical information increases the precision of MIA and CDA and may strengthen the performance of the MIA in resource-limited settings. The addition of clinical data increases the diagnostic accuracy of the minimally invasive autopsy (MIA) and complete diagnostic autopsy in 12% and 8% of the cases, respectively. The increase in concordance from MIA blind to clinical data to MIA enhanced with clinical data was significant in neonatal, adult, and maternal deaths and was also evident in children, although it did not reach statistical significance. The use of clinical data may improve the diagnostic precision of the MIA in resource-limited settings.
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Affiliation(s)
- Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Paola Castillo
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique; ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 8950 Barcelona, Spain; Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, 1100 Maputo, Mozambique
| | | | | | - Sónia Bandeira
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Calvino Sambo
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Valeria Chicamba
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Sibone Mocumbi
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Zara Jaze
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Flora Mabota
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | | | - Jordi Vila
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain.
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
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Diallo-Danebrock R, Abbas M, Groß D, Kellner U. [History of the anatomical and clinical autopsy]. DER PATHOLOGE 2018; 40:93-100. [PMID: 30062578 DOI: 10.1007/s00292-018-0461-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The history of the autopsy is naturally also a part of the history of anatomy and pathology and spans over about 2300 years. The first documented autopsies were conducted in about 300 B.C. Thereafter, due to the prohibition of dissections due to religious, social, or hygienic reasons, a long period of stagnation took place. With the onset of the Renaissance in the 15th and 16th century, interest in the ancient sciences such as anatomy began to rise and consequently an increasing number of dissections for anatomical studies were conducted. Nevertheless, it took nearly 200 years until clinical symptoms and/or causes of disease and death were correlated with anatomical findings. In the second half of the 19th century, the clinical autopsy based on the combination of macroscopic and microscopic findings became more and more important as a precondition for the systematic description of diseases. Based on autopsy findings and together with several new techniques, modern pathology could be established at the beginning of the 20th century as a source of scientific knowledge for the clinical medicine and as a theoretical discipline of its own.
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Affiliation(s)
- R Diallo-Danebrock
- Institut für Pathologie, Johannes Wesling Klinikum Minden, Paul-Ehrlich-Str. 9, 32429, Minden, Deutschland.
| | - M Abbas
- Institut für Pathologie, Johannes Wesling Klinikum Minden, Paul-Ehrlich-Str. 9, 32429, Minden, Deutschland
| | - D Groß
- Institut für Geschichte, Theorie und Ethik der Medizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - U Kellner
- Institut für Pathologie, Johannes Wesling Klinikum Minden, Paul-Ehrlich-Str. 9, 32429, Minden, Deutschland
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Methodology for the identification of vulnerable asylum seekers. Int J Legal Med 2017; 131:1719-1730. [DOI: 10.1007/s00414-017-1645-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/04/2017] [Indexed: 12/28/2022]
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