1
|
Auen T, Linde E. Do Not Turn a Blind Eye on Forensic Biochemistry: Using Vitreous Electrolytes to Reveal Renal Insufficiency as Cause of Death. Am J Forensic Med Pathol 2024:00000433-990000000-00148. [PMID: 38215054 DOI: 10.1097/paf.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
ABSTRACT In both medical and forensic autopsy, the kidneys may be overlooked grossly and histologically. As both acute and chronic kidney dysfunction have major implications on morbidity and mortality, it is essential to consider the kidneys as a pathologic source for both immediate and proximate cause of death. For decades, vitreous humor has been used as a measure of postmortem electrolyte analysis to help understand ionic disturbances carried over from the antemortem period. Renal insufficiency from both acute and chronic kidney dysfunction can be ascertained from vitreous investigations and should be a consideration for cause of death. Here, we present 4 cases in which vitreous analysis was used to determine the cause of death. In highlighting these cases, we support the use of biochemical testing in autopsy while demonstrating how it can help elucidate an often overlooked means of mortality. Importantly, it can help with the formulation of clinicopathologic correlations between antemortem and postmortem findings.
Collapse
Affiliation(s)
- Thomas Auen
- From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Erin Linde
- Physicians Laboratory Services, Omaha, NE
| |
Collapse
|
2
|
Rodrigues MAM, Miamoto B, Viero RM. Necrotizing amebic colitis in an elder patient: an unexpected autopsy finding. Autops Case Rep 2023; 13:e2023456. [PMID: 38034513 PMCID: PMC10687792 DOI: 10.4322/acr.2023.456] [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: 09/15/2023] [Accepted: 10/14/2023] [Indexed: 12/02/2023]
Abstract
Necrotizing amebic colitis is an uncommon amebiasis complication associated with high mortality. We present a case of necrotizing amebic colitis in an old patient whose diagnosis was revealed at postmortem examination. An 81-year-old man died at home without medical attention. The postmortem examination revealed ulcers involving the entire colon and intestinal perforation. The ulcers were large, geographic, and necrotizing, extending from the cecum to the rectum. The histological examination disclosed the infectious etiology by showing amebic trophozoites at the base of the ulcers. No extra-intestinal lesions were found. No information about previous episodes of dysentery or travel could be obtained. The potential role of aging or drug-causing immunosuppression and the evolution of chronic and latent intestinal infection to a severe and invasive form of amebiasis is discussed. This case reinforces the value of postmortem examination for diagnosing diseases not clinically identified.
Collapse
Affiliation(s)
| | - Bruno Miamoto
- Universidade Estadual Paulista (UNESP), Departamento de Patologia, Faculdade de Medicina de Botucatu, Botucatu, SP
| | - Rosa Marlene Viero
- Universidade Estadual Paulista (UNESP), Departamento de Patologia, Faculdade de Medicina de Botucatu, Botucatu, SP
| |
Collapse
|
3
|
Barington K, Eriksen EØ, Kudirkiene E, Pankoke K, Hartmann KT, Hansen MS, Jensen HE, Blirup-Plum SA, Jørgensen BM, Nielsen JP, Olsen JE, Goecke NB, Larsen LE, Pedersen KS. Lesions and pathogens found in pigs that died during the nursery period in five Danish farms. Porcine Health Manag 2023; 9:26. [PMID: 37264473 DOI: 10.1186/s40813-023-00319-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Diagnosing and treatment of diseases in pigs are important to maintain animal welfare, food safety and productivity. At the same time antimicrobial resistance is increasing, and therefore, antibiotic treatment should be reserved for individuals with a bacterial infection. The aim of the study was to investigate gross and histological lesions and related pathogens in pigs that died during the nursery period in five Danish farms. In addition, high throughput, real-time qPCR monitoring of specific porcine pathogens in fecal sock and oral fluid samples were carried out to investigate the between-farm and between-batch variation in the occurrence of pathogens. RESULTS Twenty-five batches of nursery pigs from five intensive, indoor herds were followed from weaning (approximately four weeks) to the end of nursery (seven to eight weeks post weaning). Gross and histological evaluation of 238 dead and 30 euthanized pigs showed the highest prevalence of lesions in the skin, respiratory system, gastrointestinal tract, and joints. Gross and histological diagnoses of lung and joint lesions agreed in 46.5% and 62.2% of selected pigs, respectively. Bacteriological detection of Escherichia coli, Streptococcus suis or Staphylococcus aureus infections in joints, lungs and livers was confirmed as genuine infection on immunohistochemical staining in 11 out of 70 tissue sections. The real-time qPCR analysis of pooled samples showed that most pathogens detected in feces and in oral fluid in general followed the same shedding patterns in consecutive batches within herds. CONCLUSIONS Gross assessment should be supplemented with a histopathological assessment especially when diagnosing lesions in the lungs and joints. Moreover, microbiological detection of pathogens should optimally be followed up by in situ identification to confirm causality. Furthermore, routine necropsies can reveal gastric lesions that may warrant a change in management. Real-time qPCR testing of fecal sock samples and oral fluid samples may be used to monitor the infections in the individual herd and testing one batch seems to have a good predictive value for subsequent batches within a herd. Overall, optimal diagnostic protocols will provide a more substantiated prescription of antibiotics.
Collapse
Affiliation(s)
- Kristiane Barington
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark.
| | - Esben Østergaard Eriksen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Egle Kudirkiene
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Karen Pankoke
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Katrine Top Hartmann
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Mette Sif Hansen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Henrik Elvang Jensen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Sophie Amalie Blirup-Plum
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Benjamin Meyer Jørgensen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Jens Peter Nielsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - John Elmerdahl Olsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Nicole Bakkegård Goecke
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Lars Erik Larsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
| | - Ken Steen Pedersen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, 1870, Frederiksberg C, Denmark
- Ø-Vet A/S, Køberupvej 33, 4700, Næstved, Denmark
| |
Collapse
|
4
|
Hagner KA, Nordgren HS, Aaltonen K, Sarjokari K, Rautala H, Sironen T, Sukura A, Rajala-Schultz PJ. Necropsy-based study on dairy cow mortality-Underlying causes of death. J Dairy Sci 2023; 106:2846-2856. [PMID: 36870842 DOI: 10.3168/jds.2022-22466] [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: 06/30/2022] [Accepted: 11/15/2022] [Indexed: 03/06/2023]
Abstract
The worldwide problem of increasing dairy cow mortality is widespread in modern production systems, it causes economic losses, and indicates problems with herd health and welfare. Most studies on causes of dairy cow mortality are limited as they are based on secondary register data, or questionnaires for producers or veterinarians, and neither necropsies nor histopathologic analyses are usually performed. For this reason, no definite causes for dairy cow deaths have been determined making it difficult or impossible to implement effective preventive measures. The objectives of this study were to (1) determine the causes of on-farm mortality of Finnish dairy cows, (2) determine the usefulness of routine histopathologic analysis in bovine necropsies, and (3) assess how reliable producers' perception about the cause of death is. Underlying diagnoses of on-farm deaths were determined through necropsy of 319 dairy cows at an incineration plant. The necropsy data were combined with background information obtained from online questionnaires covering cow and herd records. Mastitis was the most common underlying diagnosis of death (26.6%), followed by digestive disorders (15.4%), other known disorders (13.8%), calving-associated disorders (12.2%), and locomotion disorders (11.9%). The underlying diagnoses of death varied during different stages of lactation and with parity. A large proportion of the study cows (46.7%) died during the first 30 d after calving, and of those, 63.6% died during the first 5 d. A routine histopathologic analysis was performed in every necropsy, and it changed the preliminary gross diagnosis in 18.2% of the cases. Producers' perception about the cause of death agreed with the necropsy-based underlying diagnosis of death in 42.8% of the cases. It was most consistent for mastitis, calving disorders, locomotion diseases, and accidents. In cases where producers had no insights about the cause of death, necropsy revealed the final underlying diagnosis in 88.2% of cases, demonstrating the usefulness of necropsy. Based on our findings, necropsies provide useful and reliable information to develop control programs for cow mortality. Including routine histopathologic analysis in necropsies, more accurate information may be obtained. Furthermore, targeting preventive measures on transitional cows may be most effective, as the number of deaths was highest at this time.
Collapse
Affiliation(s)
- K A Hagner
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland.
| | - H S Nordgren
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland
| | - K Aaltonen
- Department of Virology, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014 Helsinki, Finland
| | | | - H Rautala
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Paroninkuja 20, 04920 Saarentaus, Finland
| | - T Sironen
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland; Department of Virology, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014 Helsinki, Finland
| | - A Sukura
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland
| | - P J Rajala-Schultz
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Paroninkuja 20, 04920 Saarentaus, Finland
| |
Collapse
|
5
|
Beer T, Bäckström B, Ottosson A, Rietz A, Michard JF, Loisel J, Sandberg O, Eriksson A. The utility of histology in assessing the cause of death in medico-legal autopsies in selected trauma deaths: Suspension-, immersion-, fire-, and traffic-related. J Forensic Sci 2023; 68:509-517. [PMID: 36645694 DOI: 10.1111/1556-4029.15193] [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: 09/12/2022] [Revised: 12/16/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
The goal of a medico-legal autopsy is primarily to determine the cause and manner of death. To this end, the pathologist often uses auxiliary analyses, including histology. However, the utility of routine histology in all medico-legal autopsies is unknown. Earlier studies on the utility of routine histology have shown inconsistent effects, with some studies recommending it and others rejecting it. To study the degree to which histology informs on the underlying cause of death, we sent autopsy reports from suspension-, immersion-, fire-, and traffic-related deaths to senior board-certified forensic pathologists and had them assess the cause of death, first without knowledge of the histological findings and then with knowledge thereof. Fifty cases were identified in each of four subgroups: fire-, immersion-, suspension-, and traffic-related deaths. The autopsy reports were anonymized, and the histological findings and conclusions were removed. Two board-certified forensic pathologists independently reviewed the reports in each subgroup and assessed the manner and underlying cause of death (including their certainty of this assessment on a five-level scale) with and without access to histological findings. The probability of changing the underlying cause of death posthistology was low in all study groups. There was a slight increase in the degree of certainty posthistology in cases where the underlying cause of death was not changed, but only when the antehistology certainty was low. Our results suggest that histology does not meaningfully inform on the underlying cause of death in suspension-, immersion-, fire-, and traffic-related deaths except when antehistology certainty is low.
Collapse
Affiliation(s)
- Torfinn Beer
- Department of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå, Sweden
| | - Björn Bäckström
- Department of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå, Sweden
| | - Anders Ottosson
- Unit for Forensic Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anders Rietz
- Department of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå, Sweden
| | | | | | - Oscar Sandberg
- Department of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå, Sweden
| | - Anders Eriksson
- Department of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Mehmood S, Aslam S, Dilshad E, Ismail H, Khan AN. Transforming Diagnosis and Therapeutics Using Cancer Genomics. Cancer Treat Res 2023; 185:15-47. [PMID: 37306902 DOI: 10.1007/978-3-031-27156-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In past quarter of the century, much has been understood about the genetic variation and abnormal genes that activate cancer in humans. All the cancers somehow possess alterations in the DNA sequence of cancer cell's genome. In present, we are heading toward the era where it is possible to obtain complete genome of the cancer cells for their better diagnosis, categorization and to explore treatment options.
Collapse
Affiliation(s)
- Sabba Mehmood
- Department of Biological Sciences, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan.
| | - Shaista Aslam
- Department of Biological Sciences, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Erum Dilshad
- Department of Bioinformatics and Biosciences, Faculty of Health and Life Sciences, Capital University of Science and Technology (CUST) Islamabad, Islamabad, Pakistan
| | - Hammad Ismail
- Departments of Biochemistry and Biotechnology, University of Gujrat (UOG) Gujrat, Gujrat, Pakistan
| | - Amna Naheed Khan
- Department of Bioinformatics and Biosciences, Faculty of Health and Life Sciences, Capital University of Science and Technology (CUST) Islamabad, Islamabad, Pakistan
| |
Collapse
|
7
|
Liver Trauma: Management in the Emergency Setting and Medico-Legal Implications. Diagnostics (Basel) 2022; 12:diagnostics12061456. [PMID: 35741266 PMCID: PMC9221646 DOI: 10.3390/diagnostics12061456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
Traumatic abdominal injuries are life-threatening emergencies frequently seen in the Emergency Department (ED). The most common is liver trauma, which accounts for approximately 5% of all ED admissions for trauma. The management of blunt liver trauma has evolved significantly over the past few decades and, according to the injury’s severity, it may require massive resuscitation, radiological procedures, endoscopy, or surgery. Patients admitted to the ED with blunt abdominal trauma require a multidisciplinary evaluation, including emergency physicians, surgeons, radiologists, and anesthetists, who must promptly identify the extent of the injury to prevent serious complications. In case of a patient’s death, the execution of a forensic examination carried out with a multidisciplinary approach (radiological, macroscopic, and histological) is essential to understand the cause of death and to correlate the extent of the injuries to the possibility of survival to be able to manage any medico-legal disputes. This manuscript aims to collect the most up-to-date evidence regarding the management of hepatic trauma in the emergency room and to explore radiological findings and medico-legal implications.
Collapse
|
8
|
de André CDS, Bierrenbach AL, Barroso LP, de André PA, Justo LT, Pereira LAA, Taniguchi MT, Minto CM, Takecian PL, Kamaura LT, Ferreira JE, Hazard RH, Mclaughlin D, Riley I, Lopez AD, Ramos AMDO, de Souza MDFM, França EB, Saldiva PHN, da Silva LFF. Validation of physician certified verbal autopsy using conventional autopsy: a large study of adult non-external causes of death in a metropolitan area in Brazil. BMC Public Health 2022; 22:748. [PMID: 35421964 PMCID: PMC9008898 DOI: 10.1186/s12889-022-13081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Reliable mortality data are essential for the development of public health policies. In Brazil, although there is a well-consolidated universal system for mortality data, the quality of information on causes of death (CoD) is not even among Brazilian regions, with a high proportion of ill-defined CoD. Verbal autopsy (VA) is an alternative to improve mortality data. This study aimed to evaluate the performance of an adapted and reduced version of VA in identifying the underlying causes of non-forensic deaths, in São Paulo, Brazil. This is the first time that a version of the questionnaire has been validated considering the autopsy as the gold standard.
Methods
The performance of a physician-certified verbal autopsy (PCVA) was evaluated considering conventional autopsy (macroscopy plus microscopy) as gold standard, based on a sample of 2060 decedents that were sent to the Post-Mortem Verification Service (SVOC-USP). All CoD, from the underlying to the immediate, were listed by both parties, and ICD-10 attributed by a senior coder. For each cause, sensitivity and chance corrected concordance (CCC) were computed considering first the underlying causes attributed by the pathologist and PCVA, and then any CoD listed in the death certificate given by PCVA. Cause specific mortality fraction accuracy (CSMF-accuracy) and chance corrected CSMF-accuracy were computed to evaluate the PCVA performance at the populational level.
Results
There was substantial variability of the sensitivities and CCC across the causes. Well-known chronic diseases with accurate diagnoses that had been informed by physicians to family members, such as various cancers, had sensitivities above 40% or 50%. However, PCVA was not effective in attributing Pneumonia, Cardiomyopathy and Leukemia/Lymphoma as underlying CoD. At populational level, the PCVA estimated cause specific mortality fractions (CSMF) may be considered close to the fractions pointed by the gold standard. The CSMF-accuracy was 0.81 and the chance corrected CSMF-accuracy was 0.49.
Conclusions
The PCVA was efficient in attributing some causes individually and proved effective in estimating the CSMF, which indicates that the method is useful to establish public health priorities.
Collapse
|
9
|
Matkowski AFI, Benbow EW. Histopathology at autopsy: why bother? Histopathology 2021; 79:77-85. [PMID: 33445222 DOI: 10.1111/his.14335] [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: 11/10/2020] [Accepted: 01/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS The frequency of histopathological sampling at autopsy varies, even though inadequate sampling may limit the value of autopsy reports. This study aims to investigate the contribution of histopathology at autopsy in a major teaching hospital. METHODS AND RESULTS A total of 532 coronial autopsy reports from Manchester Royal Infirmary were analysed retrospectively. Gross and microscopic diagnoses were compared and classified as concordant, discordant, histology needed (i.e. indeterminate or unremarkable gross findings) or autolysed. Revisions made to the cause of death following histopathology were categorised as: altered direct cause of death, altered indirect cause of death, concordant with supportive information, irrelevant or inconclusive. The study was limited to brain, heart, kidney, liver, lung and spleen. Histopathology had been requested in 141 cases (27%), which were further analysed. The greatest discordance between gross and microscopic findings was observed in the lung (11.6%). The organs most frequently requiring histopathology to provide a diagnosis were the kidney and lung, at 52.8 and 28.2%, respectively. Alterations were made to the direct cause of death in 45% of cases where histopathology was taken; it provided additional or supportive information in a further 38%. Diagnoses of primary malignancy had a sensitivity of 74% [confidence interval (CI) = 0.59-0.86] and bronchopneumonia had a sensitivity of 45% (CI = 0.29-0.62). CONCLUSION Histopathology has a major impact on the interpretation of organ pathology and determining a cause of death at autopsy.
Collapse
Affiliation(s)
| | - Emyr W Benbow
- School of Medical Sciences, University of Manchester, Manchester, UK.,Department of Histopathology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust (MFT), Manchester, UK
| |
Collapse
|
10
|
Cirielli V, Bortolotti F, Cima L, De Battisti Z, Del Balzo G, De Salvia A, Laposata C, Raniero D, Vermiglio E, Portas M, Rodegher P, Ghimenton C, Martignoni G, Eccher A, Narayanasamy M, Vergine M, Turrina S, Tagliaro F, De Leo D, Brunelli M. Consultation between forensic and clinical pathologists for histopathology examination after forensic autopsy. MEDICINE, SCIENCE, AND THE LAW 2021; 61:25-35. [PMID: 33591882 DOI: 10.1177/0025802420965763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The magnitude of the diagnostic benefit conferred by performing histopathological examinations after medico-legal/forensic autopsies remains debatable. We have tried to address this issue by reviewing a series of histopathology referrals concerning medico-legal autopsies in real-world routine practice. We present an audit of the consultations provided to forensics by clinical pathologists at our institute between 2015 and 2018. Over this period, 493 post-mortem examinations were performed by forensic pathologists. Of these cases, 52 (11%) were referred for histopathology. Gross assessment was requested in 22/52 (42%) cases. Histopathology examination was performed on single organs in 15/52 (29%) cases, primarily on the lung and heart, whereas parenchymatous multi-organ analysis was carried out in 14/52 (27%) cases. Bone-marrow sampling was studied in 4/52 (8%) cases. Immunohistochemistry was needed in 16/52 (31%) cases, special stains in 9/52 (21%) cases and molecular analysis in 4/52 (8%) cases. Focusing on technical processes, standard methodology on pre-analytical procedures was changed in 10/52 (19%) cases in order to answer specific diagnostic questions. We showed that although most of the time the diagnosis is clear by the end of dissection on the basis of the macroscopic findings, histopathology can provide, modify or confirm the cause of death in many medico-legal/forensic cases. Therefore, it is desirable that forensic pathologists and clinical pathologists establish robust working relationships in a cooperative environment. We conclude that it is important to implement guidelines based on real-world routine practice in order to identify cases where histopathology can provide useful contributions, which in our experience applied to 11% of forensic cases.
Collapse
Affiliation(s)
- Vito Cirielli
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
- Department of Prevention, Legal Medicine Unit, Azienda ULSS 8 Berica, Italy
| | - Federica Bortolotti
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Luca Cima
- Department of Clinical Service, Pathology Unit, Santa Chiara Hospital, Italy
| | - Zeno De Battisti
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Giovanna Del Balzo
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Alessandra De Salvia
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Chiara Laposata
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Dario Raniero
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Elisa Vermiglio
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Margherita Portas
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Pamela Rodegher
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Claudio Ghimenton
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Guido Martignoni
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
- Pathology Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Albino Eccher
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
| | | | - Marco Vergine
- Pathology Department, Brighton and Sussex University, University Hospitals NHS Trust, UK
| | - Stefania Turrina
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, Russia
| | - Domenico De Leo
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
- FISH Lab, Integrated University Hospital Trust of Verona, Italy
| |
Collapse
|
11
|
Humez S, Delteil C, Maurage CA, Torrents J, Capuani C, Tuchtan L, Piercecchi MD. Does the medical autopsy still have a place in the current diagnostic process? A 6-year retrospective study in two French University hospitals. Forensic Sci Med Pathol 2019; 15:10.1007/s12024-019-00170-x. [PMID: 31707602 DOI: 10.1007/s12024-019-00170-x] [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] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Abstract
Medical autopsies have been in considerable decline for several decades, in France and worldwide. We aimed to determine whether a medical autopsy still currently has a role to play in diagnosis, by analyzing its performance and diagnostic limitations. This dual-centre retrospective descriptive study included all medical autopsies performed in the university hospitals of Lille and Marseille, France, between January 2007 and December 2012. Autopsies of fetuses or stillborn infants, or those related to sudden infant deaths and research protocols were excluded. 412 medical autopsies were included. The male:female ratio was 1.5:1 and mean age was 27.3 years. Half of all autopsies were pediatric. Regarding anatomical region and/or injury mechanism, a clinical diagnosis was suggested in 52.2% of cases, an autopsy diagnosis in 55.6% and a microscopic diagnosis in 81.8%. There was very low agreement between the clinician's suggested diagnosis and the final diagnosis, both for organ specific diseases and cause of death. Agreement was moderate between autopsy diagnoses and microscopic diagnoses for organ specific diseases and low for cause of death. From our findings we concluded that an autopsy associated with microscopic examination was still valuable in diagnosing cause of death. Microscopic examination was indispensable to determine certain causes of death.
Collapse
Affiliation(s)
- Sarah Humez
- Department of Pathology, Lille University Hospital, 2 avenue Oscar Lambret, 59000, Lille, France
| | - Clémence Delteil
- Forensic Department, La Timone University Hospital, 264 rue St Pierre, 13385, Marseille Cedex 05, France.
- Aix-Marseille University, CNRS, EFS, ADÈS, Marseille, France.
- Department of Forensic Pathology, 264 rue Saint Pierre, 13385, Marseille Cedex 5, France.
| | - Claude Alain Maurage
- Department of Pathology, Lille University Hospital, 2 avenue Oscar Lambret, 59000, Lille, France
| | - Julia Torrents
- Forensic Department, La Timone University Hospital, 264 rue St Pierre, 13385, Marseille Cedex 05, France
- Department of Pathology, La Timone University Hospital, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Caroline Capuani
- Forensic Department, La Timone University Hospital, 264 rue St Pierre, 13385, Marseille Cedex 05, France
- Aix-Marseille University, CNRS, EFS, ADÈS, Marseille, France
| | - Lucile Tuchtan
- Forensic Department, La Timone University Hospital, 264 rue St Pierre, 13385, Marseille Cedex 05, France
- Aix-Marseille University, CNRS, EFS, ADÈS, Marseille, France
| | - Marie-Dominique Piercecchi
- Forensic Department, La Timone University Hospital, 264 rue St Pierre, 13385, Marseille Cedex 05, France
- Aix-Marseille University, CNRS, EFS, ADÈS, Marseille, France
| |
Collapse
|
12
|
Parai JL, Milroy CM. The Utility and Scope of Forensic Histopathology. Acad Forensic Pathol 2018; 8:426-451. [PMID: 31240055 DOI: 10.1177/1925362118797602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 07/21/2018] [Indexed: 11/16/2022]
Abstract
Forensic histopathology is the use of histology to aid in the identification of disease and injuries in forensic pathology practice. The value of routine microscopy has been challenged in various studies and discussions have taken place in forensic journals about how useful microscopic diagnosis is in medicolegal autopsies. This paper reviews the literature on the value of histological examination in forensic practice and discusses routine histochemical stains that can be used in postmortem examinations to aid in the diagnosis and add value by confirming or refuting macroscopic findings.
Collapse
|
13
|
Perrone ME, Chang A, Henriksen KJ. Medical renal diseases are frequent but often unrecognized in adult autopsies. Mod Pathol 2018; 31:365-373. [PMID: 28984299 DOI: 10.1038/modpathol.2017.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
Kidney diseases affect many hospitalized patients and contribute to morbidity and mortality. Therefore, kidney disease should be prevalent, but the frequency and spectrum of medical renal pathology in autopsy specimens has not been well documented. We sought to determine the spectrum of medical renal pathology in adult autopsy specimens and the frequency of overlooked diagnoses. We reviewed the hematoxylin- and eosin-stained kidney sections from 140 adult autopsies performed at a large teaching hospital over a 2-year period. Fifty-eight cases (41%) had findings warranting further analysis, including alterations in glomerular matrix and/or cellularity, atypical or pigmented casts, thrombi, tubulointerstitial or vascular inflammation, or deposition of amorphous material. After additional studies and clinical correlation, the pathologic changes in 43 cases (31%) were categorized as follows: diabetic nephropathy, bile cast nephropathy, thrombotic microangiopathy, infection-related glomerulonephritis, focal necrotizing/crescentic glomerulonephritis, oxalate nephropathy, light-chain cast nephropathy, amyloidosis, urate nephropathy, hemosiderosis, antineutrophil cytoplasmic antibody-associated vasculitis, polyoma virus nephropathy, atheroembolic disease, and nephrocalcinosis. These diagnoses were not reported in 26 (60%) cases during the initial autopsy evaluation. This study demonstrates that medical renal diseases are common in autopsy cases, but significant diagnoses can be easily overlooked. Autopsy kidney specimens are a rich source of renal pathology and their evaluation should be emphasized in anatomic pathology residency training. Ultimately, our understanding of how kidney disease contributes to morbidity and mortality will benefit from accurate recognition of renal pathology in autopsy specimens.
Collapse
Affiliation(s)
- Marie E Perrone
- Department of Pathology, The University of Washington, Seattle, WA, USA
| | - Anthony Chang
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Kammi J Henriksen
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
14
|
Delteil C, Tuchtan L, Torrents J, Capuani C, Piercecchi-Marti MD. Pediatric medicolegal autopsy in France: A forensic histopathological approach. J Forensic Leg Med 2017; 53:106-111. [PMID: 29232618 DOI: 10.1016/j.jflm.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
The aim of postmortem medicolegal examination in pediatric death is primarily to establish the circumstances and causes of death and to exclude child abuse. In France, pediatric death is systematically documented by medicolegal or medical autopsy. In case of medicolegal autopsy, the complementary examinations, requested and financed by justice, are rarely limited to a histopathological examination. However in medical autopsies other tools are available to the pathologist as toxicology, biochemistry and molecular biology. The purpose of this article is to evaluate the efficacy of forensic histopathology in pediatric forensic autopsies. We analyze the main causes of pediatric death in a forensic context. Between 2004 and 2015, 157 infant deaths were identified in Marseille university hospital. The forensic histopathology and autopsy reports of all 157 cases were available for systematic review. Medical or surgical causes represented 41,3% of deaths in our center, accidental causes 8.1% and child abuse 28,8%. The definitive diagnosis was made at autopsy in 30% of cases and at histopathological examination in 70% highlighting that forensic histopathology is an indispensable tool in pediatric medicolegal autopsies. Significant histological abnormalities may be detected in selected organs such as the brain, lungs, heart, liver, adrenal glands and kidneys in spite of macroscopically normal appearances. This justifies systematic sampling of all organs. Despite the implementation of the French sudden infant death protocol which recommends medical autopsies, too many pediatric autopsies are carried out in a medicolegal context. 30% of the cases remain without diagnosis at the end of the autopsy and histological examination. This number could be reduced by the contribution of others laboratory investigation.
Collapse
Affiliation(s)
- Clémence Delteil
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Lucile Tuchtan
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Julia Torrents
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France
| | - Caroline Capuani
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marie-Dominique Piercecchi-Marti
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| |
Collapse
|
15
|
Al Mahdy H. Quality of coroner's post-mortems in a UK hospital. Int J Health Care Qual Assur 2014; 27:25-35. [PMID: 24660515 DOI: 10.1108/ijhcqa-07-2012-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this paper was, principally, to look at the coroner's post-mortem report quality regarding adult medical patients admitted to an English hospital; and to compare results with Royal College of Pathologists guidelines. DESIGN/METHODOLOGY/APPROACH Hospital clinical notes of adult medical patients dying in 2011 and who were referred to the coroner's office to determine the cause of death were scrutinised. Their clinical care was also reviewed. FINDINGS There needs to be a comprehensive approach to coroner's post-mortems such as routinely taking histological and microbiological specimens. Acute adult medical patient care needs to improve. RESEARCH LIMITATIONS/IMPLICATIONS Steps should be taken to ensure that comprehensive coroner's post-mortems are performed throughout the UK, including with routine histological and microbiological specimens examination. Additionally, closer collaboration between clinicians and pathologists needs to occur to improve emergency adult medical patient clinical care. ORIGINALITY/VALUE The study highlights inadequacies in coroner's pathology services.
Collapse
|
16
|
Kuijpers CCHJ, Fronczek J, van de Goot FRW, Niessen HWM, van Diest PJ, Jiwa M. The value of autopsies in the era of high-tech medicine: discrepant findings persist. J Clin Pathol 2014; 67:512-9. [PMID: 24596140 DOI: 10.1136/jclinpath-2013-202122] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses. METHODS We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death. RESULTS Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases. CONCLUSIONS Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety.
Collapse
Affiliation(s)
| | - Judith Fronczek
- Symbiant Pathology Expert Centre, Alkmaar, The Netherlands Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Hans W M Niessen
- Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands Department of Cardiac Surgery, VU Medical Centre, Amsterdam, The Netherlands ICaR-VU, VU Medical Centre, Amsterdam, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mehdi Jiwa
- Symbiant Pathology Expert Centre, Alkmaar, The Netherlands
| |
Collapse
|
17
|
Dettmeyer RB. The role of histopathology in forensic practice: an overview. Forensic Sci Med Pathol 2014; 10:401-12. [PMID: 24577850 DOI: 10.1007/s12024-014-9536-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 12/19/2022]
Abstract
The role of forensic histopathology in routine practice is to establish the cause of death in particular cases. This is achieved on the basis of microscopic analysis of representative cell and tissue samples taken from the major internal organs and from abnormal findings made at autopsy. A prerequisite of this is adherence to the quality standards set out for conventional histological/cytological staining and enzyme histochemical and immunohistochemical methods. The interpretation of histological findings is performed by taking into account macroscopic autopsy findings and information on previous history. Histological analysis may prompt postmortem biochemical and chemical-toxicological investigations. The results of histological analysis need to be classified by experts in the context of the available information and the need to withstand the scrutiny of other experts.
Collapse
Affiliation(s)
- R B Dettmeyer
- Institute of Forensic Medicine, Justus-Liebig University Giessen, Frankfurter Str. 58, 35392, Giessen, Germany,
| |
Collapse
|
18
|
Fronczek J, Hollingbury F, Biggs M, Rutty G. The role of histology in forensic autopsies: Is histological examination always necessary to determine a cause of death? Forensic Sci Med Pathol 2013; 10:39-43. [DOI: 10.1007/s12024-013-9496-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/28/2022]
|
19
|
Tang RK, Liu Y, Liu YZ, Zhu SM, Huang W, Zhao P, Zhu Y, Yang M, Tang H, Huang AL, Li JB. Evaluation of post-mortem heart blood culture in a Chinese population. Forensic Sci Int 2013; 231:229-33. [DOI: 10.1016/j.forsciint.2013.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/26/2013] [Accepted: 05/18/2013] [Indexed: 11/16/2022]
|
20
|
Affiliation(s)
- Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
| |
Collapse
|
21
|
Implication des médecins légistes dans l’autopsie médicale : l’expérience toulousaine. Ann Pathol 2013; 33:87-92. [DOI: 10.1016/j.annpat.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/20/2012] [Accepted: 02/13/2013] [Indexed: 11/18/2022]
|
22
|
Duraiyan J, Govindarajan R, Kaliyappan K, Palanisamy M. Applications of immunohistochemistry. J Pharm Bioallied Sci 2012; 4:S307-9. [PMID: 23066277 PMCID: PMC3467869 DOI: 10.4103/0975-7406.100281] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 11/15/2022] Open
Abstract
Immunohistochemistry (IHC) is an important application of monoclonal as well as polyclonal antibodies to determine the tissue distribution of an antigen of interest in health and disease. IHC is widely used for diagnosis of cancers; specific tumor antigens are expressed de novo or up-regulated in certain cancers. This article deals with the various applications of IHC in diagnosis of diseases, with IHC playing an important role in diagnostic and research laboratories.
Collapse
Affiliation(s)
- Jeyapradha Duraiyan
- Department of Oral and Maxillofacial Pathology, Thai Moogambigai Dental College & Hospital, Chennai, India
| | | | | | | |
Collapse
|
23
|
Chatelain D, Hebert A, Trouillet N, Charfi S, Stephens P, Manaouil C, Defouilloy C, Braconnier L, Jarde O, Sevestre H. Intérêt de l’analyse anatomopathologique dans une série de 400 autopsies médicolégales. Ann Pathol 2012; 32:4-13. [DOI: 10.1016/j.annpat.2011.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 10/13/2011] [Accepted: 10/18/2011] [Indexed: 11/17/2022]
|
24
|
Immunohistochemistry utilization in autopsy pathology: A Canadian experience. Pathol Res Pract 2011; 207:241-6. [DOI: 10.1016/j.prp.2011.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 11/19/2022]
|
25
|
|
26
|
Sens MA, Zhou X, Weiland T, Cooley AM. Unexpected neoplasia in autopsies: potential implications for tissue and organ safety. Arch Pathol Lab Med 2010; 133:1923-31. [PMID: 19961246 DOI: 10.5858/133.12.1923] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2009] [Indexed: 11/06/2022]
Abstract
CONTEXT -Medical examiner cases are increasingly used as tissue donor referral sources to meet the ever-growing need for transplant tissues. The assumption is often made that traumatic and sudden deaths have minimal risk of unsuspected neoplasia. An autopsy of a registered tissue donor with strong preautopsy clinical assessment of a saddle pulmonary embolus revealed unsuspected acute lymphoblastic leukemia, prompting a review of the incidence of unsuspected neoplasia from a regional forensic autopsy practice. OBJECTIVE -To determine the incidence of (1) unsuspected neoplasia, (2) clinical concordance of known neoplasia, and (3) potential donor referral in a regional forensic autopsy service. DESIGN -A retrospective, 5-year review of 412 autopsies from a regional, primarily forensic, autopsy service to determine the incidence of unsuspected neoplasia, clinical concordance of known neoplasia, and the preautopsy assessment of potential donor referral suitability. RESULTS -Unsuspected neoplasia rate at autopsy was 7% (29 of 412 patients); cancer was the cause of death in 41% (12 of 29 patients) of these individuals. In patients with a history of cancer, the discordance of cancer diagnosis was 44% (4 of 9 patients [11 patients with known cancer, 2 who refused medical evaluation were excluded from the study]). Nearly 60% (17 of 29 patients) of the unsuspected cancer cases had no apparent reason for deferral of tissue procurement before the autopsy examination. CONCLUSIONS -The 7% incidence of unsuspected cancer in a forensic autopsy practice raises concern for the potential introduction of neoplastic tissue in the donor pool. To ensure the safety of this vital resource, mandatory complete autopsies on deceased donors are advocated as well as a tissue-recipient registry to track donor-related neoplasia.
Collapse
Affiliation(s)
- Mary Ann Sens
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202-9037, USA.
| | | | | | | |
Collapse
|
27
|
de la Grandmaison GL, Charlier P, Durigon M. Usefulness of Systematic Histological Examination in Routine Forensic Autopsy. J Forensic Sci 2010; 55:85-8. [DOI: 10.1111/j.1556-4029.2009.01240.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Ordi J, Ismail MR, Carrilho C, Romagosa C, Osman N, Machungo F, Bombí JA, Balasch J, Alonso PL, Menéndez C. Clinico-pathological discrepancies in the diagnosis of causes of maternal death in sub-Saharan Africa: retrospective analysis. PLoS Med 2009; 6:e1000036. [PMID: 19243215 PMCID: PMC2646780 DOI: 10.1371/journal.pmed.1000036] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 01/10/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. METHODS AND FINDINGS A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n = 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). CONCLUSIONS Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.
Collapse
Affiliation(s)
- Jaume Ordi
- Department of Pathology Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomédiques August Pi I Sunyer, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Duband S, Forest F, Dumollard JM, Chambonnière-Simon ML, Clémenson A, Péoc'h M. [Medical autopsies: retrospective analysis of indications and relevance of the results for the medical community]. Ann Pathol 2009; 29:4-19. [PMID: 19233088 DOI: 10.1016/j.annpat.2008.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
Abstract
AIM A retrospective study of adult autopsies and its value in a French university hospital. INTRODUCTION Despite its decline, the medical autopsy remains a major diagnostic tool to understand death mechanisms and to improve the quality of cares. OBJECTIVES Our purpose is to assess the current motivations of hospital autopsy demands, to analyze the concerned patients' medical characteristics, to determine the contribution of these with regard to the clinicians' questioning and to put the light on its limits. MATERIAL AND METHODS We reviewed the demands of adults' autopsies made in our hospital center between November 2005 and June 2008. RESULTS Eighteen demands were sent during the considered period. More than half of these demands came from intensive care units, and had for main motivations to eliminate diagnostic hypotheses or to understand the fast lethal evolution in spite of the administered treatments. The median duration of hospitalization before death was about 12 days. The average age of the patients was about 61 years. These patients had suffered on average three important pathological histories before their admittance at the hospital, which were directly responsible for the death in 56% of the observations. The autopsy allowed to establish a diagnosis in 10 cases, to complete a diagnosis in five observations and to confirm a diagnosis in four cases. The absences of diagnoses are especially due to the fast degradation of the patients' state before the realization of the adapted additional examinations. The diagnostic errors concern pathologies with a poor specific or atypical semiology, or when there is one intricacy of important pathologies. CONCLUSION The autopsy remains a contributory examination in the reviews of morbimortality and in the improvement of the care. However, for its results to be useful, they have to join a critical multidisciplinary discussion.
Collapse
Affiliation(s)
- Sébastien Duband
- Service d'anatomie et cytologie pathologiques, hôpital Nord, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 02, France
| | | | | | | | | | | |
Collapse
|
30
|
Pakis I, Karapirli M, Karayel F, Turan A, Akyildiz E, Polat O. Quality assessment of perinatal and infant postmortem examinations in Turkey. J Forensic Sci 2008; 53:1166-8. [PMID: 18637051 DOI: 10.1111/j.1556-4029.2008.00821.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An autopsy examination is important in identifying the cause of death and as a means of auditing clinical and forensic practice; however, especially in perinatal and infantile age groups determining the cause of death leads to some difficulties in autopsy practice. In this study, 15,640 autopsies recorded during the years 2000-2004 in the Mortuary Department of the Council of Forensic Medicine were reviewed. Autopsy findings of 510 cases between 20 completed weeks of gestation and 1 year of age were analyzed retrospectively. The quality of each necropsy report was assessed using a modification of the system gestational age assessment described by Rushton, which objectively scores aspects identified by the Royal College of Pathologists as being part of a necropsy. According to their ages, the cases were subdivided into three groups. Intrauterine deaths were 31% (158 cases), neonatal deaths were 24% (123 cases), and infantile deaths were 45% (229 cases) of all cases. Scores for the quality of the necropsy report were above the minimum acceptable score with 44% in intrauterine, 88% in neonatal and infantile deaths.
Collapse
Affiliation(s)
- Isil Pakis
- Pathologist, Council of Forensic Medicine, Beylikdüzü, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|