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European Heart Journal Jul 2022Historically, autopsy contributed to our current knowledge of cardiovascular anatomy, physiology, and pathology. Major advances in the understanding of cardiovascular... (Review)
Review
Historically, autopsy contributed to our current knowledge of cardiovascular anatomy, physiology, and pathology. Major advances in the understanding of cardiovascular diseases, including atherosclerosis and coronary artery disease, congenital heart diseases, and cardiomyopathies, were possible through autopsy investigations and clinicopathological correlations. In this review, the importance of performing clinical autopsies in people dying from cardiovascular disease, even in the era of advanced cardiovascular imaging is addressed. Autopsies are most helpful in the setting of sudden unexpected deaths, particularly when advanced cardiovascular imaging has not been performed. In this setting, the autopsy is often the only chance to make the correct diagnosis. In previously symptomatic patients who had undergone advanced cardiovascular imaging, autopsies still play many roles. Post-mortem examinations are important for furthering the understanding of key issues related to the underlying diseases. Autopsy can help to increase the knowledge of the sensitivity and specificity of advanced cardiovascular imaging modalities. Autopsies are particularly important to gain insights into both the natural history of cardiovascular diseases as well as less common presentations and therapeutic complications. Finally, autopsies are a key tool to quickly understand the cardiac pathology of new disorders, as emphasized during the recent coronavirus disease 2019 pandemic.
Topics: Autopsy; COVID-19; Cardiovascular Diseases; Cardiovascular System; Cause of Death; Death, Sudden; Humans
PubMed: 35514073
DOI: 10.1093/eurheartj/ehac220 -
Current Pharmaceutical Design 2017This manuscript provides an overview for analysts, medical and scientific investigators, and laboratory administrators, the range of factors that should be considered to... (Review)
Review
This manuscript provides an overview for analysts, medical and scientific investigators, and laboratory administrators, the range of factors that should be considered to implement best practice forensic toxicology. These include laboratory influence over the collection of specimens, their proper transport and chain-of-custody before arrival in the laboratory. In addition, the laboratory needs to ensure properly trained staff use suitably validated and documented analytical procedures that meet the intended purpose and type of case in an accredited or suitably quality oriented management system. To assist the investigating officers laboratory results require an interpretation over their possible significance when sufficient details are available over the circumstances of the case. This requires a thorough understanding of the various factors that influence concentrations of substances and ultimately their likely physiological effect. These include consideration of the route of ingestion, influence over chronicity of usage on tissue concentrations and tolerance, possible combined drug effects or likely adverse reactions and consideration of relevant genetic factors that may have influenced pharmacokinetic or pharmacodynamic response.
Topics: Autopsy; Forensic Toxicology; Humans; Practice Guidelines as Topic; Qualitative Research
PubMed: 28677500
DOI: 10.2174/1381612823666170704123836 -
Indian Journal of Pathology &... May 2022Fetal and perinatal autopsies are useful to identify the accurate cause of death and in the process recognize disorders which may require counselling for future... (Review)
Review
Fetal and perinatal autopsies are useful to identify the accurate cause of death and in the process recognize disorders which may require counselling for future pregnancies. Abnormalities of the CNS are an important cause of fetal loss and perinatal deaths. Most of these are structural abnormalities of the CNS, however a smaller portion show changes pertaining to prematurity, infections and even congenital tumors. In this review we evaluate CNS abnormalities of the fetus and the newborn as detected in autopsy series. We also describe our experience in a tertiary care hospital with a specialized neonatology unit over the last 8 years and discuss some of the newer methods like virtual autopsy.
Topics: Autopsy; Congenital Abnormalities; Female; Fetal Death; Fetus; Humans; Infant, Newborn; Pregnancy
PubMed: 35562151
DOI: 10.4103/ijpm.ijpm_977_21 -
Trends in Cancer Jun 2023Metastasis is a complex process and the leading cause of cancer-related death globally. Recent studies have demonstrated that genomic sequencing data from paired primary... (Review)
Review
Metastasis is a complex process and the leading cause of cancer-related death globally. Recent studies have demonstrated that genomic sequencing data from paired primary and metastatic tumours can be used to trace the evolutionary origins of cells responsible for metastasis. This approach has yielded new insights into the genomic alterations that engender metastatic potential, and the mechanisms by which cancer spreads. Given that the reliability of these approaches is contingent upon how representative the samples are of primary and metastatic tumour heterogeneity, we review insights from studies that have reconstructed the evolution of metastasis within the context of their cohorts and designs. We discuss the role of research autopsies in achieving the comprehensive sampling necessary to advance the current understanding of metastasis.
Topics: Humans; Autopsy; Reproducibility of Results; Neoplasms
PubMed: 37059687
DOI: 10.1016/j.trecan.2023.03.002 -
Archives of Pathology & Laboratory... Sep 2020The novel coronavirus disease 2019 (COVID-19) pandemic is significantly changing methodologic approaches in all branches of the health system. From a forensic point of... (Review)
Review
CONTEXT.—
The novel coronavirus disease 2019 (COVID-19) pandemic is significantly changing methodologic approaches in all branches of the health system. From a forensic point of view, this event is partly changing the manner in which forensic pathologists and all those who work in autopsy services operate, but above all, it is changing the patterns established for years by which cadavers are analyzed postmortem.
OBJECTIVE.—
To present a review of the literature and a proposal for COVID-19 autopsy protocols. To contain the infection risk, a revision of all the protocols that until now have been applied to the examination of bodies that require autopsy services is required.
DATA SOURCES.—
Currently, the diagnosis and postmortem analysis of positive or suspected COVID-19 cases plays a crucial role in scientific research. A review of the main recommendations proposed by international scientific societies regarding the risk of infection during autopsy was carried out. Scientific papers currently available via the PubMed NCBI search engine on COVID-19 postmortem diagnosis were also examined.
CONCLUSIONS.—
Throughout the history of medicine, autopsy has been fundamental to the understanding of multiple pathogenic processes that are investigated postmortem. The purpose of the study is to propose an operating protocol that can be useful for all clinical and forensic autopsies, with particular reference to the correct methods to be applied to the examination of positive or suspected COVID-19 cases, regarding both the autopsy procedure and the collection and analysis of biological samples.
Topics: Autopsy; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Infection Control; Pandemics; Pneumonia, Viral; Risk Assessment; SARS-CoV-2; Specimen Handling
PubMed: 32383963
DOI: 10.5858/arpa.2020-0165-SA -
Pediatric Critical Care Medicine : a... Aug 2018The acceptability of traditional postmortem examination to bereaved families, coupled with a misguided professional view about their limited utility, has led to decrease... (Review)
Review
OBJECTIVES
The acceptability of traditional postmortem examination to bereaved families, coupled with a misguided professional view about their limited utility, has led to decrease in this ultimate investigation. Research recurrently demonstrates that postmortem examination provides clinically relevant information despite ever-improving diagnostic techniques. This review examines postmortem examination for children who die in PICU-whether consented or nonconsented (legally mandated). It explores how such investigations might provide useful information and suggests that PICU and pathology teams work together to provide information for bereaved families to either enable them to consent to postmortem interventions or understand necessary forensic processes. Newer technologies such as postmortem imaging and laparoscope-assisted/ultrasound-guided tissue sampling are reviewed, with the hope that greater acceptability to families may lead to a welcome resurgence in postmortem information for clinicians, tempered by realization that widespread acceptance of their equivalence to standard techniques by most forensic services is awaited.
DATA SOURCES
Literature review.
STUDY SELECTION
Journal articles describing practices in pediatric and adult postmortem examination.
DATA EXTRACTION
Not available.
DATA SYNTHESIS
Not available.
CONCLUSIONS
The PICU team have a duty to help bereaved parents understand what postmortem investigations are available, or might be mandated, after the death of their child. A thoughtful, unhurried, and compassionate discussion should be arranged with expert pathology teams and any specialists who have cared for the child to explain how investigations can provide information about what is involved-including availability and suitability of newer techniques. This should include information about when a child's body, organs, or tissues will be available for the funeral, necessary legal procedures and how and when results will be explained to them.
Topics: Autopsy; Cause of Death; Child; Humans; Intensive Care Units, Pediatric; Parental Consent; Parents; Professional-Family Relations
PubMed: 30080814
DOI: 10.1097/PCC.0000000000001505 -
Pathologica Oct 2023A brief overview on the management of autopsies during the SARS-CoV-19 epidemic is proposed. In particular, the point is made of the Italian laws on the subject, the... (Review)
Review
A brief overview on the management of autopsies during the SARS-CoV-19 epidemic is proposed. In particular, the point is made of the Italian laws on the subject, the characteristics required for the autopsy room and the sampling suggested for the histological examination.
Topics: Humans; Autopsy; Severe acute respiratory syndrome-related coronavirus
PubMed: 38054900
DOI: 10.32074/1591-951X-921 -
Der Pathologe Mar 2021The COVID-19 pandemic represents a so far unknown challenge for the medical community. Autopsies are important for studying this disease, but their safety was... (Review)
Review
BACKGROUND
The COVID-19 pandemic represents a so far unknown challenge for the medical community. Autopsies are important for studying this disease, but their safety was challenged at the beginning of the pandemic.
OBJECTIVES
To determine whether COVID-19 autopsies can be performed under existing legal conditions and which safety standards are required.
MATERIALS AND METHODS
The autopsy procedure undertaken in five institutions in Germany, Austria, and Switzerland is detailed with respect to legal and safety standards.
RESULTS
In all institutions the autopsies were performed in technically feasible rooms. The personal equipment consisted of functional clothing including a disposable gown and apron, a surgical cap, eye protection, FFP‑3 masks, and two pairs of gloves. In four institutions, complete autopsies were performed; in one institution the ultrasound-guided biopsy within the postmortal imaging and biopsy program. The latter does not allow the appreciation of gross organ pathology; however, it is able to retrieve standardized biopsies for diagnostic and research purposes. Several scientific articles in highly ranked journals resulted from these autopsies and allowed deep insights into organ damage and conclusions to better understand the pathomechanisms. Viral RNA was frequently detectable in the COVID-19 deceased, but the issue of infectivity remains unresolved and it is questionable if Ct values are greater than 30.
CONCLUSIONS
With appropriate safeguards, autopsies of people who have died from COVID-19 can be performed safely and are highly relevant to medical research.
Topics: Austria; Autopsy; COVID-19; Germany; Humans; Pandemics; SARS-CoV-2; Switzerland
PubMed: 33625535
DOI: 10.1007/s00292-021-00925-w -
Tidsskrift For Den Norske Laegeforening... Aug 2021Medical autopsies are rarely made subject to quality assurance. We have investigated the quality of autopsy reports in Norway and assessed the impact of errors on the...
BACKGROUND
Medical autopsies are rarely made subject to quality assurance. We have investigated the quality of autopsy reports in Norway and assessed the impact of errors on the cause of death statistics.
MATERIAL AND METHOD
Every fifth medical autopsy report for adults (> 2 years) in 2014 was reviewed. The significance of the autopsy result for the registration of cause of death was studied by comparing the death certificate issued by the clinician with the coding in the Cause of Death Registry after the autopsy.
RESULTS
A total of 389 autopsy reports from 15 departments of pathology were reviewed. The autopsy request, as well as the death certificate and the codes for the cause of death from the Cause of Death Registry were available for 339 and 360 cases respectively. Ninety-five requests had specified clinical questions, but were commented on by the pathologist in 33 cases. Obesity was rarely reported as a finding, even in cases of pathological deviations from a normal weight. A post-mortem virus examination or toxicology had been performed in 1 and 28 autopsies respectively. The average turnaround time for autopsies without and with a neuropathological examination was 99 and 138 days respectively. Errors in reporting the cause of death or inadequate reporting were evident in 69 cases (18 %), most frequently for deaths from cardiovascular diseases. The autopsy result led to a change to the cause of death in the Cause of Death Registry in 206 out of 360 (57 %) cases for which coding data were available. Errors in the formulation of the autopsy result resulted in erroneous coding of the cause of death in 22 out of 47 (47 %) of cases with errors.
INTERPRETATION
The proportion of autopsy reports with errors in the formulation of the cause of death was unexpectedly high and may have consequences for the cause of death statistics. Long turnaround times for autopsies complicate communication with the clinician about the findings.
Topics: Adult; Autopsy; Cause of Death; Diagnostic Tests, Routine; Humans; Medical Records; Norway; Registries
PubMed: 34423952
DOI: 10.4045/tidsskr.20.1000 -
Forensic Science, Medicine, and... Mar 2016Iatrogenic deaths are a concern for patients, physicians, and public health specialists. Most medicolegal investigation jurisdictions in the United States have the legal... (Review)
Review
Iatrogenic deaths are a concern for patients, physicians, and public health specialists. Most medicolegal investigation jurisdictions in the United States have the legal authority and mandate to investigate deaths associated with diagnostic/therapeutic procedures. Given the decreasing trends of autopsies performed in U.S. hospitals, forensic pathologists are likely to take on an even greater role in investigating these deaths. This is an overview and forensic pathological approach to fatal complications due to diagnostic and therapeutic medical events.
Topics: Anesthesia; Autopsy; Cause of Death; Cross Infection; Death Certificates; Drug-Related Side Effects and Adverse Reactions; Forensic Pathology; Humans; Iatrogenic Disease; Professional Role; Pulmonary Embolism; Renal Dialysis; Surgical Procedures, Operative; Transfusion Reaction
PubMed: 26820284
DOI: 10.1007/s12024-016-9745-5