Part II begins with a list of special histologic stains, their for use and their corresponding references. At the end of this list is a procedure for removal of formalin precipitate from tissue sections.
Despite an unceasing stream of publications extolling the value of postmortem examination (1–12), the hospital autopsy rate continues to decline. Estimates, published in the 199Os, of the overall autopsy rate in the United States are as low as 5%, with the rate in academic institutions estimated at 11% (13,14). Several factors contribute to this. One is the notion that the autopsy will not reveal...
The principle of “Universal Precautions” is predicated on the assumption that all autopsies carry a significant risk of transmitting disease, either by aerosols or through the use of sharp instruments. To prevent exposure, the prosector is now mandated to wear surgical scrubs over which(s)he donsmask, head protection, apron, sleeve covers, and cut-resistant as well as latex (or rubber) gloves.
INITIAL STEPS Before the autopsy is begun, a radiogram of the chestmaybe performed (see Chapter 10). Theremoval of the chestplateis thenperformed. In patients whohavehad previous open-heart surgery via a median sternotomy, diffuse pericardial adhesions are common, which require careful dissection of theheartaway from the sternum so as not to disrupt anysurgical sites. Pericardial exudates...
The head is elevated slightly with a wooden block or a metal headrest attached to the autopsy table. The hair is parted with a comb along a coronal plane connecting one mastoid with the other over the convexity (Fig. 4-1).A sharp scalpel blade can then be used to cut through the whole thickness of the scalp from the outside. The incision should starton the right side of the head(the “viewing-side”...
The eye and the adnexal structures may be affected by systemic disease, as well as by direct extension of pathologic processes from adjacent structures. Thus, it is important to consider their removal and study during autopsy (1,2). Such primary pathologic conditions embrace notonlyneoplasms but also congenital abnormalities, primary open-angle glaucoma, and a host of retinal diseases for which the...
The environs devoted to autopsy activities should be large enough to comfortably house evisceration tables, dissection tables,a cooler for storage of bodies and supplies, cabinets for equipment, shelving for fixed specimens and unused containers, a photography stand (see Chapter 1), an X-ray machine and view box, sinks for rinsing organs, sinks for washing hands, and sufficient office space for all...
The pathologist may be tempted to obtainmultiple cultures while performing anautopsy, considering the variety of tissues and fluids that areavailable to him or her. However, the medical literature is replete with examples of discrepancies between clinical evidence of infection and postmortem culture results (1–6). These discrepancies are attributed to contamination during specimen collection (5, 6),...
Autopsy chemistry, or postmortem chemistry, is the term applied to the measurement of endogenous constituents in dead bodies. Toxicological tests, which measure concentrations of exogenous drugsand toxins, are discussed in Chapter 13. Postmortem chemical studies provide direct information concerning derangements of physiology. In contrast, customary gross and histological autopsy examinations are...
Various aneuploidies of the sex chromosomes are the most common chromosome abnormalities encountered in autopsies of adults. The Turner (usually 45,X but mosaicism is common) and Klinefelter (47,XXY) syndromes are two examples (1). Deletions or unbalanced translocations and inversions are rarely seen in autopsies of adults because patients with these abnormalities seldom survive into adulthood. Approximately...
Roentgenology provides an important supplement to modem autopsy technology. Several applications of postmortem roentgenography, in particular, angiographic procedures, have been described in Chapter 2. In addition, numerous indications for the use of autopsy roentgenography are listed throughout Part II, Therefore, in this chapter, only a brief overview shall be provided.
The current practice of medicine uses a variety of radioactive sources. These sources are introduced into a human body intentionally for medical research, diagnosis and therapy, or accidentally when there is an incident involving radioactive materials. Because incidents involving uptakes of radioactive materials are rare,medical procedures are the primary source of origin when a body is radioactive...
The prime goal of the hospital autopsy report is to provide easily accessible and concise information to the treating physician(s), and through them, the family (1). It should address whatever clinical questions arose during the care of the patient, as well as correlate autopsy findings with clinical radiographic and other diagnostic studies. A well-written autopsy report adequately prepares the clinician...
In the broadest sense, a medicolegal autopsy is any autopsy that generates an evidentiary document that forms a basis for opinions rendered in a criminal trial, deposition, wrongful death civil suit, medical malpractice civil suit, administrative hearing, or workmen’s compensation hearing. Because any autopsy report can become such a document, all autopsies should be considered medicolegal. However,...
This chapter focuses on general legal principles pertaining to autopsies in the United States.
Several factors inherent in autopsy pathology conspire to prevent or diminish good tissue preservation. There is the delay in starting the dissection, which may be hoursto several days in duration. In many instances, the body will remain unrefridgerated on the clinical floor during part of that delay. Autolysis is further hastened in obese patients because of decreased dissipation of body heat. Second,...