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PubMed1975

[Morbus Hodgkin in autopsies today (author's transl)].

In Hodgkin's disease, good clinical results are obtained by the modern combined treatment with irradiation and chemotherapy. An examination of autopsy findings show in the period 1955-1964 a mean survival time (measured from first biopsy until death) of 22 month, in the period 1965-1973 of 42 month. In contrast to first biopsies, autopsies have a prevalence to the reticular "Hodgkin-sarcoma" .41% of all cases are of this type. 12 of these cases had changed from the lymphocytic predominaut type or from nodular sclerosis, to the reticular type. This augmentation of the reticular type is seen as a consequence of modern therapy. In 18 autopsies, histologic classification was rendered impossible by massive scarring. 8 cases of the period 1965-1973 did not show any lymphogranulomatous tissue and could be morphologically defined as "cured". Therapeutic damages were found in 15 cases. 6 cases had diffuse pulmonary fibrosis. The therapy provoked scars could be differentiated histologically from the hyalinizations occurring in nodular sclerosis and in diffuse fibrosis.

Adult↗

PubMed1975

Early sterile autopsy in etiological studies on multiple sclerosis.

The clinical findings and course in the first 2 cases of multiple sclerosis are described, in whom it was possible to isolate a virus from brain tissue by early sterile autopsy and fusion technique. It is noteworthy that in one of these cases multiple sclerosis probably occurred in female members of the family through three consecutive generations. A report is made on an additional case, in which no virus could be isolated, but in which electron microscopic studies showed two types of virus particles: nucleocapsid-like structures and particles identical in form and size with papova virus. Electron microscopic findings and attempts to cultivate a virus in multiple sclerosis published by other authors are discussed. It is pointed out, that the results described provide as yet no proof for the viral etiology of multiple sclerosis. They support the hypothesis, however, that a virus may play an essential role in the etiology and/or pathogenesis of this disease. Problems in relation to brain autopsy in multiple sclerosis are discussed. Early sterile autopsy is considered the most practicable possibility for obtaining tissue material for culturing and for ultrastructural studies in multiple sclerosis.

Adult↗

PubMed1976

Asymmetric septal hypertrophy in autopsies in men.

Asymmetric septal hypertrophy (ASH) was not identified in the 2,790 autopsies performed in a Veterans Administration hospital since 1958. Recent reports consider ASH to be a common cardiac disease in the diffuse form that has extensive myofiber disorientation. A retrospective study of 419 autopsies was undertaken to see if that diagnosis had been overlooked; but, in 100 autopsies with detailed photographic records of ventricular and septal size, ASH was not found. There were slight average increases in the posterior portions of the septum and right ventricle, and an average septal-left ventricular ratio of 1.1. Since neither staff pathologists nor consultants who reviewed entire hearts with cardiomyopathy noted features of ASH, we consider it to be a rare disease in elderly veterans.

Adult↗

PubMed1975

Prevalence of cardiac tumours at autopsy in Ibadan.

The post mortem specimens, protocols, slides and hospital case notes of 6064 necropsies carried out in the University College Hospital, Ibadan over a seven year period were reviewed. Cardiac tumours were found in 64 subjects (1.06%) of all autopsies and in 8.5% of all 752 malignancies that came to autopsy during the same period. Only two of these tumours arose primarily in the heart whilst the remaining were metastatic tumours. The right side of the heart was more often involved than any other part (31.38%). The tumour with the highest cardiac involvement was Burkitt's lymphoma with an incidence of 30 cases i.e. 8.24% of all malignancies; 0.48% of all necropsies studied; 53.6% of all Burkitt's lymphoma autopsied. The risk of associating the rate of cardiac involvement of any tumour with its index of higher frequency was emphasized in the light of the paucity of involvement in a more frequent malignancy (hepatocellular) carcinoma in this environment. Routine medical examination coupled with an awareness of the possible susceptibility of the heart to secondary involvement by Burkitt's lymphoma would aid ante-mortem diagnosis of intracardiac malignancy particularly in patients of Burkitt's lymphoma age group.

Adolescent↗

PubMedDate not supplied

A review of autopsies at the University Teaching Hospital, Lusaka, 1975.

Findings in all clinical autopsies performed in 1975 are presented. The autopsy rate for all deaths was 17%, it was only 10% in childhood deaths, but rose to nearly 34% if stillbirths and neonatal deaths are excluded. The main causes of death are classified in major fields. In adults neoplasms were the commonest cause of death with acute infections and cardiac diseases following in order of importance. The value of the clinical autopsy is briefly discussed.

Adolescent↗

PubMed1978

Cost effectiveness of the autopsy in maintaining and improving the standard of patient care.

A research model has been designed to attempt to obtain data that would help make the autopsy more effective in bringing about better patient care. To maintain and improve patient care, we must demonstrate that which is good about the present state of the practice of medicine and maintain it, and those areas in which improvement is possible, and then strive to change them. The autopsy can play an important role in this process. A better understanding of the mechanism by which the autopsy achieves this key role will enhance its contributions.

Autopsy↗

PubMed1978

Caveat prosector: the pathologist and autopsy law.

For more than five centuries autopsies have contributed to the improvement of health care. To support this purpose, society has modified the laws governing the dead body. While the police power of the state authorizes some autopsies, most are performed in hospitals and are governed by the common law as locally modified. The use of living tissues and organs from dead bodies has led to efforts not only to redefine death, but also to regulate tissue banking, transplantation, and experimentation. These legal and social constraints must be recognized and respected by the autopsy pathologist.

Autopsy↗

PubMed1979

Correlation between volumetric CT imaging and autopsy measurements of glioblastoma size.

A three-dimensional reconstruction and display technique (THREAD SYSTEM) for serial computed tomography (CT) was employed in monitoring tumor volumes in two children under chemotherapy for glioblastoma multiforme of the cerebral hemispheres. Progressive diminution of tumor bulk was documented in the first patient and an increase in volume in the second. The first patient expired of the complications of his therapy and the second of transtentorial herniation. Independent measurements of the tumors as determined by a CT scan near the times of death and tumor dimensions measured at autopsy revealed good correlations between the radiographic and the anatomical data. The final CT measurement of tumor volume of 20 cm3 compared with an autopsy calculation of 13.3 cm3 in the first case. In the second case, CT volume was 417 cm3 and the actual volume of the primary tumor mass at autopsy was 437 cm3. The results suggest that the THREAD system is a practical method for monitoring the results of radiotherapy and chemotherapy in certain types of cerebral neoplasms.

Adolescent↗

PubMed1977

Endomyocardial fibrosis in Chandigarh area, India. A study of nine autopsies.

The clinical and autopsy data of nine cases of endomyocardial fibrosis encountered over a period of 11 years are presented. These account for nearly 24% of primary cardiomyopathies and 0.8% of cardiac diseases seen at autopsy. There were four cases with biventricular endomyocardial fibrosis, three with a predominantly left and two with a predominantly right ventricular affection. There was no correlation between the clinical data and the autopsy pattern of endomyocardial fibrosis; all of them presented as congestive cardiac failure.

Adolescent↗

PubMed1979

Mortality and autopsy rate for respiratory diseases in Finland in 1955--1973.

Mortality from respiratory diseases in Finland in 1955--1973 was investigated using the official statistics and original death certificates. Total mortality from respiratory diseases in men was significantly higher than in women. Total respiratory mortality in men has increased slightly since 1963, whereas in women it decreased between 1955 and 1963 but has since remained almost constant. Mortality from lung cancer increased in men constantly in the years 1955--1973, but this was not found in women. Mortality from obstructive lung diseases in men increased slightly between 1955 and 1969 but not since. This increase was recorded only for the elderly whereas the opposite trend was found in younger people. The number of deaths from pneumonia decreased between 1955 and 1963. After 1963 these deaths increased again but only in the older age groups. Mortality from pulmonary tuberculosis showed a steady decrease. In 1973 the autopsy rate was 80.6% in pneumococcal pneumonia, 65.6% in pulmonary embolism, 48.1% in bronchiectasis, and 47.0% in pulmonary tuberculosis, exceeding significantly the mean national autopsy rate which was 38.3%. This might mean that at least some of these respiratory diseases are underdiagnosed clinically as the performance of an autopsy seems to increase their relative proportion in mortality statistics.

Age Factors↗

PubMed1977

Correlation of scintigraphy with short interval autopsy in malignant focal liver disease: a study of 59 cases.

The accuracy of scintigraphy in focal liver disease was evaluated by comparing the scintigraphic and autopsy findings in 59 patients. The interval between scintigraphy and autopsy was not more than a few weeks. The overall agreement rate was 49 in 59 (83%), with four out of 26 (15%) false positive and six out of 33 (18%) false negative reports. Defects smaller than 2 1/2 cm were the principal source of false negative reports. The accuracy of interpretation in cases with liver weights up to 2000 g was significantly (P less than 0.025) lower than for higher weights. Detection of a single focal lesion by scintigraphy was found to be unreliable (only two out of 13 correct). Estimation of spleen weights by scintigraphy was disappointing. Liver weight estimates were somewhat more satisfactory.

Adult↗

PubMed1979

Latent thyroid carcinoma at autopsy: a study from Oporto, Portugal.

Thirty-nine (6.5%) latent thyroid carcinomas were found in 600 thyroid glands removed at autopsy in Oporto Medical School Laboratory of Pathology. The prevalence of latent thyroid carcinomas was significantly higher in women (sex ratio 4.3:1) and in elderly people (p less than 0.005) and appeared to be independent from the existence of another malignant neoplasm. The mean thyroid weight and the concurrent thyroid pathology of patients with thyroid carcinomas were not significantly different from those of patients without them. The study of cervical lymph nodes in the first 400 autopsies did not show any significant difference concerning histologic pattern, number of germinal centers and sinus histiocytosis between patients with thyroid carcinomas and those without them. Further investigation is required to evaluate the role of host factors on the peculiar characteristics of latent thyroid carcinomas.

Adolescent↗

PubMed1975

[Special and functional pathomorphology of parathyroid glands as revealed in non-selected autopsies (589 cases) (author's transl)].

1637 parathyroid gland dissections were performed on 589 unselected autopsy preparations in order to study both pathomorphology and functional aspects in an unselected group of patients. In no case had primary or tertiary hyperparathyroidism been suspected clinically; but in about 10 patients on chronic hemodialysis, a secondary hyperplasia of the glands was known. In about 33% of the cases pathological changes were observed: 3 chief cell adenomas, 3 adenomas combined with hyperplasia, 12 primary nodular hyperplasias including 6 microadenomas and 145 cases with secondary regulative hyperplasia. Cysts, purulent parathyroiditis, lipomatous pseudohyperplasia, metastases of carcinomas, hemorrhagic infarctions and amyloidosis were also detected in serial sections of the parathyroid glands. The remarkably large group of secondary hyperplasias (about 20%) was divided into 3 categories according to weight and cytology. The first category (118 cases) was characterized by a lack of the normal age-related involution of the parenchyma and prevalence of light (active) chief cells. Statistical evaluation of the other autopsy findings, histomorphology of the bone in particular, led to the conclusion that this group represented a slightly activated gland with possibly reversible hyperplasia, mostly connected with pathological alterations in the kidney and with minimal changes in bone morphology consistent with hyperparathyroidism. The microadenomas displayed different levels of endocrine activity as demonstrated by bone histology in accordance with the cytology of the adenomas (dark or resting chief cells versus active chief cells and waterclear cells). No specific alterations with respect to endocrine function could be attributed to diffuse and nodular hyperplasia of oxyphil (oncocytic) cells except their increase with age and arteriosclerosis, especially in women.

Adenoma↗

PubMed1979

The protective effect of BCG vaccination as indicated by autopsy studies.

In a detailed study of the pathology of tuberculous infection made in Finland in 1961, tuberculous foci were found at autopsy in 61 of 67 non-vaccinated subjects and in 35 of 83 BCG-vaccinated subjects, all of whom had died between the ages of 1 and 45 years (with 2 exceptions from causes other than tuberculosis). In the present note on the same material, national information on tuberculin sensitivity and tuberculosis mortality has been used to calculate the risk of tuberculous infection in Finland at different times and ages during the lifetime of these subjects. From these risks of infection in Finland it was estimated that 63 or 64 of the non-vaccinated subjects had been infected during their lifetime and that between 25 and 31 of the BCG-vaccinated subjects were expected to have been naturally infected (had they not been vaccinated) between the time of vaccination and death. It is concluded that virtually all tuberculous infections in unvaccinated subjects lead to pulmonary foci, which are demonstrable at autopsy. Further, the same appears to be so in vaccinated subjects; there is no evidence to support the suggestion that in man BCG vaccine can prevent the establishment of infection in an exposed subject. The effects of BCG (as demonstrated in the earlier paper) appear to be confined to limiting the multiplication and dissemination of the bacilli and the development of lesions following infection.

Adolescent↗

PubMed1979

Disseminated intravascular coagulation in autopsy cases. Its incidence and clinicopathologic significance.

In a study of 1729 consecutive autopsies, the histopathologic diagnosis of disseminated intravascular coagulation (DIC) confirmed by the presence of microthrombi in more than two organs was made in 51 cases. Among them, 38 cases (74.5%) were clinically not suspected of having DIC. Microthrombi were most frequent in the kidneys, followed by the lungs, spleen, adrenals, heart, brain, and liver, in descending order of frequency. Furthermore, a wide variety of visceral lesions was another important histologic feature of DIC. Kidney lesions assumed a position of prime importance, and special attention was given to the high frequency of acute renal failure due to so-called acute tubular necrosis and bilateral renal cortical necrosis. Infections, often associated with shock, and malignancies were the most common underlying causes of DIC. DIC is a frequent, often fatal pathophysiologic condition complicating many disorders. The true incidence of DIC at autopsy may be higher. It should be noted that demonstration of microthrombi and visceral alterations related to intravascular clotting is important for the evaluation of cases suspected of having DIC.

Adrenal Glands↗

PubMed1976

[A review of the findings on chest examinations and at autopsy in surgical patients under intensive care (author's transl)].

The present paper deals with the findings on examination of the chest and at autopsy in 100 selected surgical patients under intensive care; of these 17% were post-traumatic, 55% had post-operative lung complications and in 28% there had been no trauma or previous operations. The accuracy of the radiological diagnosis was checked against the autopsy findings. Pneumonia and pulmonary oedema were the most common lung complications in all three groups, with an incidence of 59 to 82%, and were diagnosed with an accuracy of 92 to 95%. Other conditions which were looked for were pulmonary congestion, emboli and lung infarcts, pleural effusions, atelectasis, pulmonary haemorrhage or contusion and pneumothorax. The most common mis-diagnosis was in the demonstration of emboli and infarcts, where accuracy was only 64%. The difficulties in differential diagnosis of the radiological appearances due to these pulmonary complications are discussed.

Autopsy↗

PubMed1975

Cytomegalovirus studies of autopsy tissue. I. Virus isolation.

From January through September 1973, 55 virus isolates were recovered from lung and kidney specimens from 44 (8.8%) of 502 unselected autopsy cases. Cytomegalovirus (CMV) was isolated 42 times in 34 cases (36 from lung, four from kidney, and one each from pleural and bronchial tissues). Virus isolation was approximately six times more sensitive than histologic detection of CMV infections. Major causes of death included solid malignant tumors, leukemia, lymphoma, and renal allograft rejection; 13 patients had a variety of other diseases, predominantly cardiopulmonary. CMV was recovered from more males than females. The mean age of the CMV-positive group did not differ significantly from that of the CMV-negative group. CMV-positive cases were not preselected on the basis of specimen processing time. Serologic results indicate that recovery of CMV from an autopsy case was seven times more likely when the complement-fixing antibody titer was 1:16 or more.

Autopsy↗

PubMed1979

Reliability of immunofluorescence of renal tissue obtained at autopsy.

A retrospective study of kidney tissues accessioned in the Department of Immunopathology was undertaken to determine the reliability of the direct immunofluorescence technic applied to necropsy tissues. Of 72 accessioned specimens, 27 were positive and showed a spectrum of immunomicroscopic patterns corresponding to different renal diseases. Only two patients whose specimens were negative by immunofluorescence had shown any clinical or light microscopic evidence of active glomerular disease. Periods from death to autopsy ranged from one to 20 hours. Positive fluorescence was found in tissues obtained as long as 20 hours after death. These findings suggest that immunofluorescent studies of autopsy-derived renal tissue yield acceptable results.

Acute Kidney Injury↗