BACKGROUND Information on liver involvement in patients with coronavirus disease 2019 is currently fragmented.AIM To highlight the pathological changes found during the autopsy of severe acute respiratory syndrome cor...BACKGROUND Information on liver involvement in patients with coronavirus disease 2019 is currently fragmented.AIM To highlight the pathological changes found during the autopsy of severe acute respiratory syndrome coronavirus 2 positive patients.METHODS A systematic literature search on PubMed was carried out until June 21,2022.RESULTS A literature review reveals that pre-existing liver disease and elevation of liver enzyme in these patients are not common;liver enzyme elevations tend to be seen in those in critical conditions.Despite the poor expression of viral receptors in the liver,it seems that the virus is able to infect this organ and therefore cause liver damage.Unfortunately,to date,the search for the virus inside the liver is not frequent(16%of the cases)and only a small number show the presence of the virus.In most of the autopsy cases,macroscopic assessment is lacking,while microscopic evaluation of livers has revealed the frequent presence of congestion(42.7%)and steatosis(41.6%).Less frequent is the finding of hepatic inflammation or necrosis(19%)and portal inflammation(18%).The presence of microthrombi,frequently found in the lungs,is infrequent in the liver,with only 12%of cases presenting thrombotic formations within the vascular tree.CONCLUSION To date,the greatest problem in interpreting these modifications remains the association of the damage with the direct action of the virus,rather than with the inflammation or alterations induced by hypoxia and hypovolemia in patients undergoing oxygen therapy and decompensated patients.展开更多
A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.Th...A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.展开更多
Advanced Extramammary Paget’s disease (AEMPD) shows a poor prognosis despite multimodality therapy. In recent years, it is suggested that anti-HER2 therapy may be promising for HER2-positive AEMPD. We herein present ...Advanced Extramammary Paget’s disease (AEMPD) shows a poor prognosis despite multimodality therapy. In recent years, it is suggested that anti-HER2 therapy may be promising for HER2-positive AEMPD. We herein present an autopsy case of a patient with AEMPD treated with multimodality treatment including anti-HER2 therapy. A 78-year-old man who diagnosed with AEMPD died after surgery and systemic chemotherapy including anti-HER2 therapy (trastuzumab). The metastatic skin lesions were immnohistologically HER2-positive. While the patients were administrated trastuzumab plus taxan (docetaxel, and paclitaxel) regimen, the metastatic skin lesion decreased, however, brain metastases were found in his brain and trastuzumab is discontinued. The skin metastasis rapidly spread over his body, leading to weakness, and he eventually died. At autopsy, the lesions of EMPD were extended distant organs including brain, although each metastasis was small and asymptomatic. The wide lesion of skin metastasis was exacerbated after discontinuation of trastuzumab, and transudate was observed due to the extensive necrosis and erosion. Our autopsy findings showed one progressive pattern of AEMPD, and indicated what is the clinical and pathological significance of anti HER2 therapy for HER2-positive AEMPD.展开更多
AIM: To assess the distribution of proteins coded by genes reported as relevant for the molecular classification of hepatocellular carcinoma(HCC).METHODS: In this retrospective cross-sectional study, the following cli...AIM: To assess the distribution of proteins coded by genes reported as relevant for the molecular classification of hepatocellular carcinoma(HCC).METHODS: In this retrospective cross-sectional study, the following clinicopathological data were analyzed in 80 autopsied HCC patients: sex, age, ethnicity, alcohol intake, infection with hepatitis B and/or C virus, infection with human immunodeficiency virus, prior treatment, basic and immediate causes of death, liver weight, presence of cirrhosis, number and size of nodules, gross pattern, histological grade and variants, architectural pattern, invasion of large veins, and presence and location of extrahepatic metastases. The protein products of genes known to be involved in molecular pathogenesis of HCC, including epidermal growth factor receptor(EGFR), MET, keratin 19(K19), vimentin, beta-catenin, mechanistic target of rapamycin(m TOR), extracellular signaling-relatedkinase(ERK)1, ERK2, Ki67, cyclin D1, caspase 3 and p53, were detected by immunohistochemistry on tissue microarrays. The expression levels were scored and statistically assessed for correlation with HCC parameters. RESULTS: Infection with hepatitis C virus was identified in 49% of the 80 autopsy patients, cirrhosis in 90%, advanced tumors in 95%, and extrahepatic metastases in 38%. Expression of K19, p53 and ERK1 correlated to high-grade lesions. Expression of ERK1, nuclear beta-catenin, cyclin D1 and ERK2 correlated to higher rates of cell proliferation as determined by Ki67. Expression of MET, EGFR(> 0) and caspase 3 correlated with lower histological grades. Expression o f E G F R c o r r e l a t e d t o t h a t o f c a s p a s e 3, a n d overexpression of EGFR(≥ 200/300) was observed in low-grade tumors more frequently(grades 1 and 2: 67% vs grade 3: 27% and grade 4: 30%). Expression of ERK1 was associated with that of K19 and vimentin, whereas expression of ERK2 was associated with that of cyclin D1, MET and membrane beta-catenin. Expression of vimentin was strongly correlated with that of K19. CONCLUSION: Expression of K19, p53, ERK1, ERK2, vimentin and nuclear beta-catenin was related to highergrade markers, as opposed to expression/overexpression of EGFR, MET and caspase 3.展开更多
Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at ho...Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.展开更多
BACKGROUND Mortality and cause of death data are fundamental to health policy development.Civil Registration and Vital Statistics systems are the ideal data source,but the system is still under development in Indonesi...BACKGROUND Mortality and cause of death data are fundamental to health policy development.Civil Registration and Vital Statistics systems are the ideal data source,but the system is still under development in Indonesia.A national Sample Registration System(SRS)has provided nationally representative mortality data from 128 subdistricts since 2014.Verbal autopsy(VA)is used in the SRS to obtain causes of death.The quality of VA data must be evaluated as part of the SRS data quality assessment.AIM To assess the strength of evidence used in the assignment of Ischaemic Heart Disease(IHD)as causes of death from VA.METHODS The sample frame for this study is the 4,070 deaths that had IHD assigned as the underlying cause in the SRS 2016 database.From these,400 cases were randomly selected.A data extraction form and data entry template were designed to collect relevant data about IHD from VA questionnaires.A standardised categorisation was designed to assess the strength of evidence used to infer IHD as a cause of death.A pilot test of 50 cases was carried out.IBM SPSS software was used in this study.RESULTS Strong evidence of IHD as a cause of death was assigned based on surgery for coronary heart disease,chest pain and two out of:sudden death,history of heart disease,medical diagnosis of heart disease,or terminal shortness of breath.More than half(53%)of the questionnaires contained strong evidence.For deaths outside health facilities,VA questionnaires for male deaths contained acceptable evidence in significantly higher proportions as compared to those for female deaths.(P<0.001).Nearly half of all IHD deaths were concentrated in the 50-69 year age group(48.40%),and a further 36.10%were aged 70 years or more.Nearly two-thirds of the deceased were male(58.40%).Smoking behaviour was found in 44.11%of IHD deaths,but this figure was 73.82%among males.CONCLUSION More than half of the VA questionnaires from the study sample were found to contain strong evidence to infer IHD as the cause of death.Results from medical records such as electrocardiograms,coronary angiographies,and load tests could have improved the strength of evidence and contributed to IHD cause of death diagnosis.展开更多
Forensic research requires the application of reliable identification methods for unidentified individuals, among which the dental analysis has prime importance. The most significant source of dental evidence is oral ...Forensic research requires the application of reliable identification methods for unidentified individuals, among which the dental analysis has prime importance. The most significant source of dental evidence is oral autopsy applications, which consist of an examination and evidence collection from the oral cavity of a deceased individual. Oral autopsies show variations depending on the age of the person due to rigor mortis. The oral autopsy of a child may require an easier operation than adults, and thus, the procedures are usually simpler for fetus or infant cases. The aim of this study is to propose the theoretical and experimental aspects of an oral autopsy protocol for a special age group of fetus or infant cases, which is a method for extracting tooth germs in their developmental stages for identification purposes and entitled by the authors’ names as the “Aka-Canturk Oral Autopsy Method”.展开更多
Ellis Van Creveld (EVC) syndrome is one of the congenital anomalies not compatible with life. It is also known as chondroectodermal dysplasia. The most common manifestations of this syndrome are short ribs, postaxial ...Ellis Van Creveld (EVC) syndrome is one of the congenital anomalies not compatible with life. It is also known as chondroectodermal dysplasia. The most common manifestations of this syndrome are short ribs, postaxial polydactyly, growth retardation, and ectodermal and cardiac defects. It has an incidence of one in every 60,000 live births and equal sex predisposition. In our case, perinatal autopsy was performed in a stillborn baby of 32 weeks of gestation having syndactyly, polydactyly and short forearms to know the cause of death and the diagnosis emerged as EVC syndrome. It is important to diagnose EVC syndrome as it is transmitted as an autosomal recessive disorder, so genetic counseling is required to make parents aware of the risk of recurrence.展开更多
We experienced the autopsy cases that the deceased was alive in emergency room on arrival. Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities ...We experienced the autopsy cases that the deceased was alive in emergency room on arrival. Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities for performance improvements identified in patients who died from traffic trauma and were considered by the quality improvement of education system. We focused the abdominal traffic trauma injury. An autopsy-based cross-sectional study was conducted. A purposive sampling technique was applied to select the study sample of 41 post-mortems of road traffic accident. 16 patients (39.0%) were abdominal trauma injury. The mean period of survival after meeting with accident was 13.5 hours, and compared abdominal trauma death was 27.4 hours longer. In road traffic accidents, the most injured abdominal organs were the liver followed by mesentery. We thought that delayed treatment was associated with immediate diagnostic imaging, and so expected to expand trauma management examination.展开更多
The aim of this research is to propose an innovative technique of the psychological autopsy.Compared to the classic MAPI model,our procedure is structured on each single case by adapting the interview to the environme...The aim of this research is to propose an innovative technique of the psychological autopsy.Compared to the classic MAPI model,our procedure is structured on each single case by adapting the interview to the environmental circumstances,the socio-cultural characteristics of the subject examined and to the weapon used in the criminal act.We believe that this approach improves both confidence and compliance of the interviewee and the chances of obtaining information that could escape a standardized investigation.In one of the cold cases we studied,this new protocol led to the discovery of biological material coming from the crime scene,which had been secretly hidden by the subject for over 50 years.The aim of our work was also to coordinate the activity of the interviewer,trying to avoid repetition in the interviews that could lead to an alteration of the answers to the questions asked.In the first phase,questions with open-ended responses were preferred.In later stages,we asked specifically worded questions.We were careful not to formulate questions that had already been asked.It must be emphasized that for each case of psychological autopsy only one operator handled the interview.展开更多
To investigate the possibility of benign prostatic hyperplasia (BPH) in prostatic outer gland by transrectal ultrasound (TRUS) and autopsy examination.Methods Fifty-nine patients were biopsied by TRUS guided in sagitt...To investigate the possibility of benign prostatic hyperplasia (BPH) in prostatic outer gland by transrectal ultrasound (TRUS) and autopsy examination.Methods Fifty-nine patients were biopsied by TRUS guided in sagittal and longitudinal sections,respectively,because hypoechoic nodules were found in the outer glands of the prostates.The specimens were stained by HE methods.The whole prostate specimens obtained from 16 men at autopsy were studied.Sonogram of the specimens was investigated by putting them in water.Them the specimens were sliced down perpendicularly to the urethra,histologically processed and stained by HE methods.Results Pathologically,22 of the 59 specimens were of benign prostate hyperplasia (BPH),29 of prostate cancer (PCa),1 of prostatic intraepithelial neoplasia (PIN) and 7 of tuberculosis (TB).A clear-cut interface between inner gland and outer gland,and multiple calculi and cysts were found on sonogram.Pathological diagnosis of BPH of the outer glands was made in all HE-stained autopsied specimens with varying degrees of hyperplasia of the glands,small muscles and stroma.Conclusion It is suggested that hypoechoic nodules in outer gland of the prostate by TRUS on sonogram may be benign hyperplastic nodules besides PCa,PIN,and TB.10 refs,5 figs.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)disease can frequently affect the liver.Data on hepatic histopathological findings in COVID-19 is scarce.AIM To characterize hepatic pathological findings in patients with ...BACKGROUND Coronavirus disease 2019(COVID-19)disease can frequently affect the liver.Data on hepatic histopathological findings in COVID-19 is scarce.AIM To characterize hepatic pathological findings in patients with COVID-19.METHODS We conducted a systematic review with meta-analysis registered on PROSPERO(CRD42020192813),following PRISMA guidelines.Eligible trials were those including patients of any age and COVID-19 diagnosis based on a molecular test.Histopathological reports from deceased COVID-19 patients undergoing autopsy or liver biopsy were reviewed.Articles including less than ten patients were excluded.Proportions were pooled using random-effects models.Q statistic and I2 were used to assess heterogeneity and levels of evidence,respectively.RESULTS We identified 18 studies from 7 countries;all were case reports and case series from autopsies.All the patients were over 15 years old,and 67.2%were male.We performed a meta-analysis of 5 studies,including 116 patients.Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1%[95%confidence interval(CI):46.2-63.8],congestion of hepatic sinuses 34.7%(95%CI:7.9-68.4),vascular thrombosis 29.4%(95%CI:0.4-87.2),fibrosis 20.5%(95%CI:0.6-57.9),Kupffer cell hyperplasia 13.5%(95%CI:0.6-54.3),portal inflammation 13.2%(95%CI:0.1-48.8),and lobular inflammation 11.6%(95%CI:0.3-35.7).We also identified the presence of venous outflow obstruction,phlebosclerosis of the portal vein,herniated portal vein,periportal abnormal vessels,hemophagocytosis,and necrosis.CONCLUSION We found a high prevalence of hepatic steatosis and vascular thrombosis as major histological liver features.Other frequent findings included portal and lobular inflammation and Kupffer cell hyperplasia or proliferation.Further studies are needed to establish the mechanisms and implications of these findings.展开更多
Background:Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide.Gastrointestinal tuberculosis is an unusual presentation.It is defined as the involvem...Background:Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide.Gastrointestinal tuberculosis is an unusual presentation.It is defined as the involvement of any segment of the digestive tract,associated viscera,and peritoneum.The study’s main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia.Methods:This is a retrospective and descriptive study of autopsy reports.A total of 4,500 autopsies were performed between January 2004 and December 2020.The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization.Results:Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study.Most of the patients were male(n=35,72.9%)with a median age of 40.5 years old.Human immunodeficiency virus infection history was reported in 28 cases(58.33%).The most affected gastrointestinal tract site was the terminal ileum.Ulcers and thickened epithelium were common autopsies macroscopic findings.Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis.Conclusions:Gastrointestinal tuberculosis is a disease of great importance,being its diagnosis a clinical challenge.Underdiagnosis can be reported in a high percentage of cases,so autopsy diagnosis can help reveal more accurate data about this condition.展开更多
Since the start of the COVID-19 pandemic,there has been an urgent need to produce accurate and sensitive tests.However,there have been instances where a positive nucleic acid test turns negative after treatment,and th...Since the start of the COVID-19 pandemic,there has been an urgent need to produce accurate and sensitive tests.However,there have been instances where a positive nucleic acid test turns negative after treatment,and then positive again.This case report describes such an instance from the tropical region of Hainan,China.The patient was a 61-year-old female who went to Hainan on vacation from Wuhan during the COVID-19 pandemic in 2020.Symptoms appeared 9 d after arriving in Hainan,and it was confirmed that the nucleic acid test was positive after 4 repeats.Her condition declined rapidly,her heart stopped beating,and she was admitted in a coma to the ICU.After treatment,the SARS-CoV-2 virus nucleic acid test of several nasopharyngeal swabs were negative,and tests on whole blood,anal swabs,and urine were also negative.Later,however,nucleic acid tests on a lower respiratory tract sputum swab and lower respiratory tract lavage fluid were positive.An autopsy examination was carried out 12h after her death,and multi-organ secretions were extracted for nucleic acid testing.The SARS-CoV-2 virus nucleic acid was only detected in the swabs from the end of the bronchus,which was confirmed by the visualization of the coronavirus by electron microscopy.Autopsy confirmed that the damage was mainly concentrated in the lungs and immune organs and tissues throughout the body.Epidemiology indicated that none of the people she came into contact with after arriving in Hainan,including close contacts,were infected.This is in sharp contrast to the highly contagious virus in Wuhan in the temperate zone during the same period.This case report indicates:(1)The high temperatures in tropical areas may have an impact on the spread and harm of COVID-19,and(2)The reason why nucleic acid testing for COVID-19 was initially negative and then positive after treatment may be related to the survival of the SARS-CoV-2 virus in deep lung tissues.展开更多
In December 2017,a decomposed unidentified body was found near the river Tronto in Teramo,Italy.The corpse was found without any identifying documents or specific personal belongings,except for a packet of cigarettes....In December 2017,a decomposed unidentified body was found near the river Tronto in Teramo,Italy.The corpse was found without any identifying documents or specific personal belongings,except for a packet of cigarettes.The medical examiner determined a gastric perforation from the intake of hydrochloric acid to be the cause of death.A jar of muriatic acid found near the body led to suicide being considered the manner of death.The Penal Court in Teramo appointed two forensic odontologists to complete the postmortem assessment and collect dental data for personal identification.The corpse was found wearing a complete set of upper and lower dentures.The dental autopsy and 42 periapical X-ray images helped generate a biological profile of a man totally edentulous with upper and lower dentures,as well as an osteosynthesis with two plates and screws in the left ascending ramus of the mandible.In March 2018,the sister of a missing person reported the disappearance of her brother,and a presumptive identification was performed through visual recognition of the decomposed body.The sister confirmed the presence of two dentures and the location of the maxillo-facial surgery for the treatment of the fractured mandible.A complete dental autopsy was able to establish his identity without any DNA comparison needed.This case highlights the importance of performing a complete dental autopsy inclusive of dental radiographs,and its value in the identification of all unknown human remains even when totally edentulous.A complete dental autopsy should be performed in all cases of human identification.展开更多
The objective of the study is to compare the results of virtual autopsy and traditional autopsy and then to analyze the advantages and disadvantages of them.three cases with postmortem computed tomography(CT)examinati...The objective of the study is to compare the results of virtual autopsy and traditional autopsy and then to analyze the advantages and disadvantages of them.three cases with postmortem computed tomography(CT)examination and autopsy were selected.The CT images were sent to radiologists for interpretation and were compared with autopsy results.In the cases of death in traffic accidents,the two examination conclusions are relatively consistent;in the cases of sudden cardiac death,the information provided by virtual autopsy is limited;virtual autopsy has more strength on showing some lesions such as pneumatosis and fracture.Virtual autopsy has high application value in traffic accident cases,while its application in some sudden death cases remains to be improved.展开更多
We report a 27-year-old male from Kuwait who died due to melioidosis,and the diagnosis was achieved after the deceased underwent postmortem examination at the Forensic Department,Kuala Lumpur Hospital.While the diseas...We report a 27-year-old male from Kuwait who died due to melioidosis,and the diagnosis was achieved after the deceased underwent postmortem examination at the Forensic Department,Kuala Lumpur Hospital.While the disease is endemic in Southeast Asia and Northern Australia,human melioidosis infection has yet been reported in Kuwait.He was initially diagnosed as acute gastroenteritis at a private clinic before being found dead at a hotel in Kuala Lumpur.The autopsy revealed positive findings of Burkholderia pseudomallei in the deceased brain,lung,liver,and spleen as well as in the blood and cerebrospinal fluid culture.The deceased^death highlights the importance of early accurate diagnosis,the common manifestations,and the need of effective antibiotic treatment of septicemic melioidosis in high prevalent areas.展开更多
At any time during the current coronavirus disease(COVID-19)pandemic period,forensic pathologists of public security departments in China may come in contact with corpses of unknown or unclear disease history.When the...At any time during the current coronavirus disease(COVID-19)pandemic period,forensic pathologists of public security departments in China may come in contact with corpses of unknown or unclear disease history.When these forensic pathologists perform autopsies on corpses with unknown cause of death,they inevitably face a high risk of severe acute respiratory syndrome coronavirus 2019(SARS-CoV-2)infection throughout the autopsy process.In the present paper,the various aspects of the autopsy procedure for corpses with unknown cause of death,including preautopsy preparations,personnel protection,autopsy operations,postautopsy disinfection,and equipment requirements,were explored on the basis of relevant laws and regulations such as the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases,characteristics of the novel coronavirus and COVID-19,guidelines for epidemic prevention and control,the guiding opinions on the regulation of on-site inspection and handling processes during the COVID-19 pandemic period issued by the ministry of public security,and the current practices of public security forensic pathologists.Recommendations for the autopsy procedure and protection measures for public security forensic pathologists during the COVID-19 pandemic period have been proposed to provide a reference for frontline forensic pathologists and judicial authenticators.展开更多
文摘BACKGROUND Information on liver involvement in patients with coronavirus disease 2019 is currently fragmented.AIM To highlight the pathological changes found during the autopsy of severe acute respiratory syndrome coronavirus 2 positive patients.METHODS A systematic literature search on PubMed was carried out until June 21,2022.RESULTS A literature review reveals that pre-existing liver disease and elevation of liver enzyme in these patients are not common;liver enzyme elevations tend to be seen in those in critical conditions.Despite the poor expression of viral receptors in the liver,it seems that the virus is able to infect this organ and therefore cause liver damage.Unfortunately,to date,the search for the virus inside the liver is not frequent(16%of the cases)and only a small number show the presence of the virus.In most of the autopsy cases,macroscopic assessment is lacking,while microscopic evaluation of livers has revealed the frequent presence of congestion(42.7%)and steatosis(41.6%).Less frequent is the finding of hepatic inflammation or necrosis(19%)and portal inflammation(18%).The presence of microthrombi,frequently found in the lungs,is infrequent in the liver,with only 12%of cases presenting thrombotic formations within the vascular tree.CONCLUSION To date,the greatest problem in interpreting these modifications remains the association of the damage with the direct action of the virus,rather than with the inflammation or alterations induced by hypoxia and hypovolemia in patients undergoing oxygen therapy and decompensated patients.
文摘A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.
文摘Advanced Extramammary Paget’s disease (AEMPD) shows a poor prognosis despite multimodality therapy. In recent years, it is suggested that anti-HER2 therapy may be promising for HER2-positive AEMPD. We herein present an autopsy case of a patient with AEMPD treated with multimodality treatment including anti-HER2 therapy. A 78-year-old man who diagnosed with AEMPD died after surgery and systemic chemotherapy including anti-HER2 therapy (trastuzumab). The metastatic skin lesions were immnohistologically HER2-positive. While the patients were administrated trastuzumab plus taxan (docetaxel, and paclitaxel) regimen, the metastatic skin lesion decreased, however, brain metastases were found in his brain and trastuzumab is discontinued. The skin metastasis rapidly spread over his body, leading to weakness, and he eventually died. At autopsy, the lesions of EMPD were extended distant organs including brain, although each metastasis was small and asymptomatic. The wide lesion of skin metastasis was exacerbated after discontinuation of trastuzumab, and transudate was observed due to the extensive necrosis and erosion. Our autopsy findings showed one progressive pattern of AEMPD, and indicated what is the clinical and pathological significance of anti HER2 therapy for HER2-positive AEMPD.
基金Supported by Fundacao de Amparo a Pesquisa do Estado de Sao Paulo,No.08/58855-3 to Alves VAF
文摘AIM: To assess the distribution of proteins coded by genes reported as relevant for the molecular classification of hepatocellular carcinoma(HCC).METHODS: In this retrospective cross-sectional study, the following clinicopathological data were analyzed in 80 autopsied HCC patients: sex, age, ethnicity, alcohol intake, infection with hepatitis B and/or C virus, infection with human immunodeficiency virus, prior treatment, basic and immediate causes of death, liver weight, presence of cirrhosis, number and size of nodules, gross pattern, histological grade and variants, architectural pattern, invasion of large veins, and presence and location of extrahepatic metastases. The protein products of genes known to be involved in molecular pathogenesis of HCC, including epidermal growth factor receptor(EGFR), MET, keratin 19(K19), vimentin, beta-catenin, mechanistic target of rapamycin(m TOR), extracellular signaling-relatedkinase(ERK)1, ERK2, Ki67, cyclin D1, caspase 3 and p53, were detected by immunohistochemistry on tissue microarrays. The expression levels were scored and statistically assessed for correlation with HCC parameters. RESULTS: Infection with hepatitis C virus was identified in 49% of the 80 autopsy patients, cirrhosis in 90%, advanced tumors in 95%, and extrahepatic metastases in 38%. Expression of K19, p53 and ERK1 correlated to high-grade lesions. Expression of ERK1, nuclear beta-catenin, cyclin D1 and ERK2 correlated to higher rates of cell proliferation as determined by Ki67. Expression of MET, EGFR(> 0) and caspase 3 correlated with lower histological grades. Expression o f E G F R c o r r e l a t e d t o t h a t o f c a s p a s e 3, a n d overexpression of EGFR(≥ 200/300) was observed in low-grade tumors more frequently(grades 1 and 2: 67% vs grade 3: 27% and grade 4: 30%). Expression of ERK1 was associated with that of K19 and vimentin, whereas expression of ERK2 was associated with that of cyclin D1, MET and membrane beta-catenin. Expression of vimentin was strongly correlated with that of K19. CONCLUSION: Expression of K19, p53, ERK1, ERK2, vimentin and nuclear beta-catenin was related to highergrade markers, as opposed to expression/overexpression of EGFR, MET and caspase 3.
文摘Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.
基金Supported by the Department of Foreign Affairs and Trade,Australian Government,under the Government Partnership for Development program,No.70856
文摘BACKGROUND Mortality and cause of death data are fundamental to health policy development.Civil Registration and Vital Statistics systems are the ideal data source,but the system is still under development in Indonesia.A national Sample Registration System(SRS)has provided nationally representative mortality data from 128 subdistricts since 2014.Verbal autopsy(VA)is used in the SRS to obtain causes of death.The quality of VA data must be evaluated as part of the SRS data quality assessment.AIM To assess the strength of evidence used in the assignment of Ischaemic Heart Disease(IHD)as causes of death from VA.METHODS The sample frame for this study is the 4,070 deaths that had IHD assigned as the underlying cause in the SRS 2016 database.From these,400 cases were randomly selected.A data extraction form and data entry template were designed to collect relevant data about IHD from VA questionnaires.A standardised categorisation was designed to assess the strength of evidence used to infer IHD as a cause of death.A pilot test of 50 cases was carried out.IBM SPSS software was used in this study.RESULTS Strong evidence of IHD as a cause of death was assigned based on surgery for coronary heart disease,chest pain and two out of:sudden death,history of heart disease,medical diagnosis of heart disease,or terminal shortness of breath.More than half(53%)of the questionnaires contained strong evidence.For deaths outside health facilities,VA questionnaires for male deaths contained acceptable evidence in significantly higher proportions as compared to those for female deaths.(P<0.001).Nearly half of all IHD deaths were concentrated in the 50-69 year age group(48.40%),and a further 36.10%were aged 70 years or more.Nearly two-thirds of the deceased were male(58.40%).Smoking behaviour was found in 44.11%of IHD deaths,but this figure was 73.82%among males.CONCLUSION More than half of the VA questionnaires from the study sample were found to contain strong evidence to infer IHD as the cause of death.Results from medical records such as electrocardiograms,coronary angiographies,and load tests could have improved the strength of evidence and contributed to IHD cause of death diagnosis.
文摘Forensic research requires the application of reliable identification methods for unidentified individuals, among which the dental analysis has prime importance. The most significant source of dental evidence is oral autopsy applications, which consist of an examination and evidence collection from the oral cavity of a deceased individual. Oral autopsies show variations depending on the age of the person due to rigor mortis. The oral autopsy of a child may require an easier operation than adults, and thus, the procedures are usually simpler for fetus or infant cases. The aim of this study is to propose the theoretical and experimental aspects of an oral autopsy protocol for a special age group of fetus or infant cases, which is a method for extracting tooth germs in their developmental stages for identification purposes and entitled by the authors’ names as the “Aka-Canturk Oral Autopsy Method”.
文摘Ellis Van Creveld (EVC) syndrome is one of the congenital anomalies not compatible with life. It is also known as chondroectodermal dysplasia. The most common manifestations of this syndrome are short ribs, postaxial polydactyly, growth retardation, and ectodermal and cardiac defects. It has an incidence of one in every 60,000 live births and equal sex predisposition. In our case, perinatal autopsy was performed in a stillborn baby of 32 weeks of gestation having syndactyly, polydactyly and short forearms to know the cause of death and the diagnosis emerged as EVC syndrome. It is important to diagnose EVC syndrome as it is transmitted as an autosomal recessive disorder, so genetic counseling is required to make parents aware of the risk of recurrence.
文摘We experienced the autopsy cases that the deceased was alive in emergency room on arrival. Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities for performance improvements identified in patients who died from traffic trauma and were considered by the quality improvement of education system. We focused the abdominal traffic trauma injury. An autopsy-based cross-sectional study was conducted. A purposive sampling technique was applied to select the study sample of 41 post-mortems of road traffic accident. 16 patients (39.0%) were abdominal trauma injury. The mean period of survival after meeting with accident was 13.5 hours, and compared abdominal trauma death was 27.4 hours longer. In road traffic accidents, the most injured abdominal organs were the liver followed by mesentery. We thought that delayed treatment was associated with immediate diagnostic imaging, and so expected to expand trauma management examination.
文摘The aim of this research is to propose an innovative technique of the psychological autopsy.Compared to the classic MAPI model,our procedure is structured on each single case by adapting the interview to the environmental circumstances,the socio-cultural characteristics of the subject examined and to the weapon used in the criminal act.We believe that this approach improves both confidence and compliance of the interviewee and the chances of obtaining information that could escape a standardized investigation.In one of the cold cases we studied,this new protocol led to the discovery of biological material coming from the crime scene,which had been secretly hidden by the subject for over 50 years.The aim of our work was also to coordinate the activity of the interviewer,trying to avoid repetition in the interviews that could lead to an alteration of the answers to the questions asked.In the first phase,questions with open-ended responses were preferred.In later stages,we asked specifically worded questions.We were careful not to formulate questions that had already been asked.It must be emphasized that for each case of psychological autopsy only one operator handled the interview.
文摘To investigate the possibility of benign prostatic hyperplasia (BPH) in prostatic outer gland by transrectal ultrasound (TRUS) and autopsy examination.Methods Fifty-nine patients were biopsied by TRUS guided in sagittal and longitudinal sections,respectively,because hypoechoic nodules were found in the outer glands of the prostates.The specimens were stained by HE methods.The whole prostate specimens obtained from 16 men at autopsy were studied.Sonogram of the specimens was investigated by putting them in water.Them the specimens were sliced down perpendicularly to the urethra,histologically processed and stained by HE methods.Results Pathologically,22 of the 59 specimens were of benign prostate hyperplasia (BPH),29 of prostate cancer (PCa),1 of prostatic intraepithelial neoplasia (PIN) and 7 of tuberculosis (TB).A clear-cut interface between inner gland and outer gland,and multiple calculi and cysts were found on sonogram.Pathological diagnosis of BPH of the outer glands was made in all HE-stained autopsied specimens with varying degrees of hyperplasia of the glands,small muscles and stroma.Conclusion It is suggested that hypoechoic nodules in outer gland of the prostate by TRUS on sonogram may be benign hyperplastic nodules besides PCa,PIN,and TB.10 refs,5 figs.
基金Supported by Chilean Government Through the Fondo Nacional de Desarrollo Científico y Tecnológico,No.1200227,No.1191183 and No.1191145Comisión Nacional de Investigación Científica y Tecnológica (CONICYT,CARE Chile UC),No.AFB170005European Union’s Horizon 2020 Research,No.825510
文摘BACKGROUND Coronavirus disease 2019(COVID-19)disease can frequently affect the liver.Data on hepatic histopathological findings in COVID-19 is scarce.AIM To characterize hepatic pathological findings in patients with COVID-19.METHODS We conducted a systematic review with meta-analysis registered on PROSPERO(CRD42020192813),following PRISMA guidelines.Eligible trials were those including patients of any age and COVID-19 diagnosis based on a molecular test.Histopathological reports from deceased COVID-19 patients undergoing autopsy or liver biopsy were reviewed.Articles including less than ten patients were excluded.Proportions were pooled using random-effects models.Q statistic and I2 were used to assess heterogeneity and levels of evidence,respectively.RESULTS We identified 18 studies from 7 countries;all were case reports and case series from autopsies.All the patients were over 15 years old,and 67.2%were male.We performed a meta-analysis of 5 studies,including 116 patients.Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1%[95%confidence interval(CI):46.2-63.8],congestion of hepatic sinuses 34.7%(95%CI:7.9-68.4),vascular thrombosis 29.4%(95%CI:0.4-87.2),fibrosis 20.5%(95%CI:0.6-57.9),Kupffer cell hyperplasia 13.5%(95%CI:0.6-54.3),portal inflammation 13.2%(95%CI:0.1-48.8),and lobular inflammation 11.6%(95%CI:0.3-35.7).We also identified the presence of venous outflow obstruction,phlebosclerosis of the portal vein,herniated portal vein,periportal abnormal vessels,hemophagocytosis,and necrosis.CONCLUSION We found a high prevalence of hepatic steatosis and vascular thrombosis as major histological liver features.Other frequent findings included portal and lobular inflammation and Kupffer cell hyperplasia or proliferation.Further studies are needed to establish the mechanisms and implications of these findings.
文摘Background:Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide.Gastrointestinal tuberculosis is an unusual presentation.It is defined as the involvement of any segment of the digestive tract,associated viscera,and peritoneum.The study’s main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia.Methods:This is a retrospective and descriptive study of autopsy reports.A total of 4,500 autopsies were performed between January 2004 and December 2020.The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization.Results:Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study.Most of the patients were male(n=35,72.9%)with a median age of 40.5 years old.Human immunodeficiency virus infection history was reported in 28 cases(58.33%).The most affected gastrointestinal tract site was the terminal ileum.Ulcers and thickened epithelium were common autopsies macroscopic findings.Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis.Conclusions:Gastrointestinal tuberculosis is a disease of great importance,being its diagnosis a clinical challenge.Underdiagnosis can be reported in a high percentage of cases,so autopsy diagnosis can help reveal more accurate data about this condition.
基金supported by grants from the National Natural Science Foundation of China(grand numbers 81560304 and 82060341).
文摘Since the start of the COVID-19 pandemic,there has been an urgent need to produce accurate and sensitive tests.However,there have been instances where a positive nucleic acid test turns negative after treatment,and then positive again.This case report describes such an instance from the tropical region of Hainan,China.The patient was a 61-year-old female who went to Hainan on vacation from Wuhan during the COVID-19 pandemic in 2020.Symptoms appeared 9 d after arriving in Hainan,and it was confirmed that the nucleic acid test was positive after 4 repeats.Her condition declined rapidly,her heart stopped beating,and she was admitted in a coma to the ICU.After treatment,the SARS-CoV-2 virus nucleic acid test of several nasopharyngeal swabs were negative,and tests on whole blood,anal swabs,and urine were also negative.Later,however,nucleic acid tests on a lower respiratory tract sputum swab and lower respiratory tract lavage fluid were positive.An autopsy examination was carried out 12h after her death,and multi-organ secretions were extracted for nucleic acid testing.The SARS-CoV-2 virus nucleic acid was only detected in the swabs from the end of the bronchus,which was confirmed by the visualization of the coronavirus by electron microscopy.Autopsy confirmed that the damage was mainly concentrated in the lungs and immune organs and tissues throughout the body.Epidemiology indicated that none of the people she came into contact with after arriving in Hainan,including close contacts,were infected.This is in sharp contrast to the highly contagious virus in Wuhan in the temperate zone during the same period.This case report indicates:(1)The high temperatures in tropical areas may have an impact on the spread and harm of COVID-19,and(2)The reason why nucleic acid testing for COVID-19 was initially negative and then positive after treatment may be related to the survival of the SARS-CoV-2 virus in deep lung tissues.
文摘In December 2017,a decomposed unidentified body was found near the river Tronto in Teramo,Italy.The corpse was found without any identifying documents or specific personal belongings,except for a packet of cigarettes.The medical examiner determined a gastric perforation from the intake of hydrochloric acid to be the cause of death.A jar of muriatic acid found near the body led to suicide being considered the manner of death.The Penal Court in Teramo appointed two forensic odontologists to complete the postmortem assessment and collect dental data for personal identification.The corpse was found wearing a complete set of upper and lower dentures.The dental autopsy and 42 periapical X-ray images helped generate a biological profile of a man totally edentulous with upper and lower dentures,as well as an osteosynthesis with two plates and screws in the left ascending ramus of the mandible.In March 2018,the sister of a missing person reported the disappearance of her brother,and a presumptive identification was performed through visual recognition of the decomposed body.The sister confirmed the presence of two dentures and the location of the maxillo-facial surgery for the treatment of the fractured mandible.A complete dental autopsy was able to establish his identity without any DNA comparison needed.This case highlights the importance of performing a complete dental autopsy inclusive of dental radiographs,and its value in the identification of all unknown human remains even when totally edentulous.A complete dental autopsy should be performed in all cases of human identification.
基金The project was funded by National Key R&D Program of China(2018YFC0807203)National Key R&D Program of China(2018YFC0800701).
文摘The objective of the study is to compare the results of virtual autopsy and traditional autopsy and then to analyze the advantages and disadvantages of them.three cases with postmortem computed tomography(CT)examination and autopsy were selected.The CT images were sent to radiologists for interpretation and were compared with autopsy results.In the cases of death in traffic accidents,the two examination conclusions are relatively consistent;in the cases of sudden cardiac death,the information provided by virtual autopsy is limited;virtual autopsy has more strength on showing some lesions such as pneumatosis and fracture.Virtual autopsy has high application value in traffic accident cases,while its application in some sudden death cases remains to be improved.
文摘We report a 27-year-old male from Kuwait who died due to melioidosis,and the diagnosis was achieved after the deceased underwent postmortem examination at the Forensic Department,Kuala Lumpur Hospital.While the disease is endemic in Southeast Asia and Northern Australia,human melioidosis infection has yet been reported in Kuwait.He was initially diagnosed as acute gastroenteritis at a private clinic before being found dead at a hotel in Kuala Lumpur.The autopsy revealed positive findings of Burkholderia pseudomallei in the deceased brain,lung,liver,and spleen as well as in the blood and cerebrospinal fluid culture.The deceased^death highlights the importance of early accurate diagnosis,the common manifestations,and the need of effective antibiotic treatment of septicemic melioidosis in high prevalent areas.
文摘At any time during the current coronavirus disease(COVID-19)pandemic period,forensic pathologists of public security departments in China may come in contact with corpses of unknown or unclear disease history.When these forensic pathologists perform autopsies on corpses with unknown cause of death,they inevitably face a high risk of severe acute respiratory syndrome coronavirus 2019(SARS-CoV-2)infection throughout the autopsy process.In the present paper,the various aspects of the autopsy procedure for corpses with unknown cause of death,including preautopsy preparations,personnel protection,autopsy operations,postautopsy disinfection,and equipment requirements,were explored on the basis of relevant laws and regulations such as the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases,characteristics of the novel coronavirus and COVID-19,guidelines for epidemic prevention and control,the guiding opinions on the regulation of on-site inspection and handling processes during the COVID-19 pandemic period issued by the ministry of public security,and the current practices of public security forensic pathologists.Recommendations for the autopsy procedure and protection measures for public security forensic pathologists during the COVID-19 pandemic period have been proposed to provide a reference for frontline forensic pathologists and judicial authenticators.
