Autopsy Statistics Research Articles

Changes in Clinical and Legal Autopsy Rates in Korea from 2001 to 2015.

BackgroundThe autopsy is the medical examination of a deceased person that mainly provides information on the cause and manner of death. Two types are conducted in Korea: clinical and legal, depending on its purpose. Despite this procedure's importance, autopsy rates have been decreasing worldwide. The aim of this study was to determine the nationwide autopsy rate in Korea and compare it with that in other countries.MethodsWe collected data of autopsies performed between 2001 and 2015 by searching previously published literature on autopsy statistics and by requesting data from the relevant institutions. We calculated the autopsy rate by using mortality data from Statistics Korea; furthermore, we investigated the type of autopsy performed by institution as well as by geographical region.ResultsThe total autopsy rate in Korea increased from 2.16% in 2001 to 2.60% in 2015. In terms of autopsy types, however, clinical autopsy rates decreased from 0.17% in 2001 to 0.03% in 2015, while legal autopsy rates increased from 1.99% to 2.57% during the same period. Moreover, the clinical autopsy rate tended to decrease throughout the period, while the legal autopsy rate fluctuated between 2001 and 2010 but steadily increased thereafter.ConclusionThe autopsy rate in Korea is lower compared to that of the advanced countries. These findings implicate the need for nationwide policy to promote both clinical and legal autopsy, which remain crucial parts of medical science and public health.

Growth report of “The End”-Autopsy statistics in a developing medical college

Growth report of “The End”-Autopsy statistics in a developing medical college

Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma.

General Increase.--There is rather general agreement that the incidence of bronchiogenic carcinoma has greatly increased in the last half-century. Statistical studies at the Charity Hospital of New Orleans (Ochsner and DeBakey), (1) the St. Louis City Hospital (Wheeler) (2) and the Veterans Administration Hospital of Hines, Ill. (Avery) (3) have revealed that at these hospitals cancer of the lung is now the most frequent visceral cancer in men. Autopsy statistics throughout the world show a great increase in the incidence of bronchiogenic carcinoma in relation to cancer in general. Kenneway and Kenneway, (4) in a careful statistical study of death certificates in England and Wales from 1928 to 1945, have presented undoubted evidence of a great increase in deaths from cancer of the lung. In this country statistics compiled by the American Cancer Society show a similar trend during the past two decades? Tobacco as a Possible Cause of Increase.--The suggestion that smoking, and in particular cigaret smoking, may be important in the production of bronchiogenic carcinoma has been made by many writers on the subject-even though well controlled and large scale clinical studies are lacking. Adler (6) in 1912 was one of the first to think that tobacco might play some role in this regard. Tylecote, (7) Hoffman, (8) McNally, (9) Lickint, (10) Arkin and Wagner, (11) Roffo (12) and Maier (13) were just a few of the workers who thought that there was some evidence that tobacco was an important factor in the increase of cancer of the lungs. Muller (14) in 1939, from a careful but limited clinical statistical study, offered good evidence that heavy smoking is an important etiologic factor. In 1941 Ochsner and DeBakey (15) called attention to the similarity of the curve of increased sales of cigarets in this country to the greater prevalence of primary cancer of the lung. They emphasized the possible etiologic relationship of cigaret smoking to this condition. In a recent paper Schrek (16) concluded that there is strong circumstantial evidence that cigaret smoking is an etiologic factor in cancer of the respiratory tract and finds that his data are in agreement with the results of a preliminary report presented by Wynder and Graham at the National Cancer Conference in February 1949. (17) Purpose of Study.--The purpose of the present study was to attempt to determine, so far as possible by clinical investigations, statistical methods and experimental studies, the importance of various exogenous factors that might play a role in the induction of bronchiogenic carcinoma. In this regard we intended to learn the relative importance of previous diseases of the lungs, rural and urban distribution of patients, various occupations and hereditary background as well as smoking habits. By obtaining all this information, we hoped to determine whether any of these factors, either singly or in combination, have had an effect in increasing the incidence of bronchiogenic carcinoma. In the present paper the chief emphasis will be placed on our findings in regard to smoking. METHOD OF STUDY The results of this study are based on 684 cases of proved bronchiogenic carcinoma. It should be emphasized that the results in this report have not been obtained from hospital records since we learned at the outset of our study that the routine records did not supply satisfactory answers to our questions. It was therefore decided to seek the desired information by special interviews. Six hundred and thirty-four patients reported on in this paper have been personally interviewed, and in 33 cases we obtained the information by mailing a questionnaire. (18) In the remaining 17 cases information for the questionnaire was obtained from a person who had been intimately acquainted with the patient throughout his adult life. Through the cooperation of many hospitals and physicians throughout all parts of the country who permitted us to interview their patients, it is felt that a fairly good cross section of the entire United States has been obtained. …

The history of bronchial carcinoma

Up to the mid 19 (th) century primary bronchial carcinoma was unknown. Primary tumours and metastases of malignant lung tumours were often not distinguished one from the other. Only in 1871, Theodor Langhans from Marburg reported the first certain observation of bronchial carcinoma. Definite information on the increasing frequency of lung and bronchial carcinomas at the beginning of the 20 (th) century was only obtained by autopsy statistics. The Cancer Registry of the Saarland showed that the incidence of lung cancer has not increased since 1970 in men, but has tripled in women. Already in 1923, Theodor Fahr from Hamburg referred to the danger of smoking. In Germany the so-called Schneeberg's lung cancer plays an important role among occupational lung cancer diseases. Only after Germany's reunification the drama of the uranium miners of the former so-called Wismut AG became fully known. Regarding occupational diseases, asbestos-related bronchial carcinomas and mesotheliomas are at the top of the causes of death today.

Visceral artery aneurysms

The purpose of this article is to review the etiology, clinical presentation and treatment options of visceral artery aneurysms (VAA) on the basis of our experiences. Visceral artery aneurysms are uncommon lesions with a frequency of 0,1-0,2 % in autopsy statistics. In fact many visceral artery aneurysms still present first with a rupture (22 %) and despite emergency laparotomies the mortality rate is about 8,5 %. The course of disease often is disastrous due to rupture of the aneurysms or thromboembolic complications, emphasizing the importance to be aware of this differential diagnosis of abdominal pain. This article covers 9 patients with VAA. 3 patients each revealed an a. lienalis aneurysm and a. gastrica aneurysm, resp. In the other 3 patients an aneurysm of the a. gastroepiploica, the a. pancreatico-duodenalis and the a. mesenterica superior resp. was proven. In 8 of 9 patients a surgical therapy of the VAA took place. Only 2 patients (22 %) were interventionally treated. 1 patient deceased due to postoperative hemorrhage. Both the surgical and the radiological intervention therapy are available for treatment of the VAA. The decision on the choice of the therapeutic procedure should be made on an individual basis.

Bayesian nonparametric estimation via Gibbs sampling for coherent systems with redundancy

We consider a coherent system S consisting of m independent components for which we do not know the distributions of the components’ lifelengths. If we know the structure function of the system, then we can estimate the distribution of the system lifelength by estimating the distributions of the lifelengths of the individual components. Suppose that we can collect data under the ‘autopsy model’, wherein a system is run until a failure occurs and then the status (functioning or dead) of each component is obtained. This test is repeated n times. The autopsy statistics consist of the age of the system at the time of breakdown and the set of parts that are dead by the time of breakdown. We develop a nonparametric Bayesian estimate of the distributions of the component lifelengths and then use this to obtain an estimate of the distribution of the lifelength of the system. The procedure is applicable to machine-test settings wherein the machines have redundant designs. A parametric procedure is also given.

Thirty-year autopsy statistics of myocardial diseases in Japan

心筋症を含む心筋疾患は比較的まれな疾患であり, 疫学的知見は十分でない. そこで, 日本病理学会編の日本病理剖検輯報を用いて, 1958-1987年の30年間の本邦病理解剖例に現れる心筋疾患を抽出し, その特徴を明らかにして, 心筋症の病因解明に供することを試みた. その結果, 以下の知見を得た. (1) 心筋症剖検例は1970年代後半より急激に増加していた. 心筋炎には2-3年周期の変動があり, 当初より一貫して漸増傾向がみられた. (2) 拡張型心筋症では男性が多く, 肥大型心筋症では性差はなかった. 心筋炎では女性が多かった. (3) 拡張型および肥大型心筋症の年齢分布では, 初期には20歳代と50歳代の2峰性のピークを認めたが, その後高齢化が進み, 1980年代には, それぞれ50歳代, 60-70歳代がピークとなった. (4) 肥大型心筋症では悪性腫瘍・腎硬化症の合併を高率に認めた. (5) 小児における心筋症の頻度は成人の約半分, 心筋炎のそれは成人とほぼ同じであった. 小児においては, 心筋症と心筋炎の推移により密接な関連がみられた. (6) 原発性心内膜線維弾性症は女児に多く, 周期性は見られたものの, 増加や減少の傾向はなく, その剖検例中出現率は, 全年齢心筋炎のそれと密接な関係が見られた. 以上より心筋症の一部では, 病因あるいは死因に心筋炎との関連が示唆された. また, 原発性心内膜線維弾性症の病因として母胎内感染の関与が考えられた.

Primary adrenocortical tumors in autopsy records —A survey of “cumulative reports in Japan” from 1973 to 1984—

All cases of primary adrenocortical tumors, including those found incidentally, recorded in the Pathological Autopsy Case Annuals of Japan during a 12 year period from 1973 to 1984 were surveyed. Age- and sex-specific incidences of lesions were estimated from the population, mortality and autopsy statistics for the same period. There were 101 adenomas, 77 of which were presumed to be non-functional, and 222 carcinomas. The age-specific distribution profiles of both the benign and malignant tumors showed single peaks in the sixties and could not be distinguished from one another. The estimated age-specific distribution of morbidity of the non-functional adenomas showed a peak at about 10 years younger than that found in the autopsy records, although it was again similar to that of carcinoma derived from various clinical reports. The morbidity of the non-functional adenomas per 100,000 population was almost equal to that of breast cancer in Japan, being highest in the fifties age group with more than 4,000 people a year being suggested to have adenoma in this age bracket.

The autopsy and vital statistics

Vital statistics in the United States are collected through a decentralized, cooperative system of various levels of government administrated by the National Center for Health Statistics. Although registration of all deaths is virtually complete and demographic items are accurate, the reliability of cause of death data is hampered by the current state of medical knowledge, the incompleteness of information available at the time of death, the way in which physicians complete death certificates, and the system of classification of underlying cause. The need for quality assurance in national cause of death statistics can be met in large part by connecting the autopsy to the mainstream of vital statistics. Through case by case individual linkage of death certificates and autopsies in designated demographic and/or geographic areas, a representative, continuously collected, population-based system of aggregated autopsy data would be created. Demographic and clinical selection bias should be checked and adjusted through traditional methods of epidemiologic standardization. Such a use of autopsy information could further pathology's goals of understanding disease and improving the public health.

Twenty year autopsy statistics of myocarditis incidence in Japan.

In the annuals of autopsy records in Japan, edited by the Japanese Society of Pathology and covering 20 years, from 1958 to 1977, 377841 autopsy cases are registered with a short summary of the pathology findings. Of these, 434 cases with idiopathic, interstitial, viral, non-specific (NSM) and giant cell (GCM) myocarditis were found. The incidences of NSM and GCM were 0.11 and 0.007%, respectively. The annual incidence of NSM showed periodic fluctuations with in 5-year intervals and increased remarkably after 1974. Incidence of GCM showed a similar fluctuation but with a one to two year delay of peaks. The male to female ratio was 1.2: 1 and the age distribution had two peaked patterns for both sexes, though these peaks were scattered widely from neonate to elderly patients. The regional distribution of NSM showed a concentration in the middle portion of Honshu and its regional annual incidence had propagation waves from the central area to peripheral areas. The same tendency was observed in GCM cases. Hokkaido was characterized by a low incidence of NSM and no GCM. Complications of myocarditis included pancreatitis, pneumonitis, interstitial nephritis, meningoencephalitis, hepatitis, hepatic cirrhosis and a considerable incidence of malignancies. Antibiotics, antineoplastic agents, steroids and irradiation therapy were the main forms of treatment applied before or after the start of myocarditis.

Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma

<h3>General Increase.—</h3> There is rather general agreement that the incidence of bronchiogenic carcinoma has greatly increased in the last half-century. Statistical studies at the Charity Hospital of New Orleans (Ochsner and DeBakey),¹the St. Louis City Hospital (Wheeler)²and the Veterans Administration Hospital of Hines, Ill. (Avery)³have revealed that at these hospitals cancer of the lung is now the most frequent visceral cancer in men. Autopsy statistics throughout the world show a great increase in the incidence of bronchiogenic carcinoma in relation to cancer in general. Kenneway and Kenneway,⁴in a careful statistical study of death certificates in England and Wales from 1928 to 1945, have presented undoubted evidence of a great increase in deaths from cancer of the lung. In this country statistics compiled by the American Cancer Society show a similar trend during the past two decades.⁵ <h3>Tobacco as a Possible Cause</h3>

Histological subtypes of bronchial carcinoma and their biological behavior

The WHO classification of pulmonary tumors, Geneva 1981, is used to describe the biological and morphological characteristics of the various types of bronchial tumors. The differences in frequency are noted for clinical biopsy material and autopsy statistics for squamous-epithelium cancers and small-cell bronchial carcinomas. The latter are incorrectly seen as undifferentiated cancers. Their particular hormonal activity and leading role among the hormone-producing lung tumors is emphasized. Their relationship to the carcinoids is also discussed briefly. The causes of the relatively common adrenal metastases are listed. The biological-morphological characteristics of the adeno- and bronchiolo-alveolar cancers, as well as of the giant-cell carcinomas, are mentioned.

Estimation of the lifetime distribution of the parts from the autopsy statistics of the machine

Given a coherent reliability system, let Z be the age of the machine at breakdown, and I the set of parts dead by time Z. We prove that if all lifetime distributions are non-atomic and share the same essential extrema, and if the incidence matrix of the minimal cut sets has rank equal to the number of parts, then the joint distribution of Z and I determines uniquely the lifetime distribution of each part. We present a Newton–Kantorovič iterative method for the computation of those distributions. We deal informally with the relaxation of the assumptions and with the statistical problem where instead of the joint distribution of Z and I we have an empirical estimate of this joint distribution.

Estimation of the lifetime distribution of the parts from the autopsy statistics of the machine

Given a coherent reliability system, let Z be the age of the machine at breakdown, and I the set of parts dead by time Z. We prove that if all lifetime distributions are non-atomic and share the same essential extrema, and if the incidence matrix of the minimal cut sets has rank equal to the number of parts, then the joint distribution of Z and I determines uniquely the lifetime distribution of each part. We present a Newton–Kantorovič iterative method for the computation of those distributions. We deal informally with the relaxation of the assumptions and with the statistical problem where instead of the joint distribution of Z and I we have an empirical estimate of this joint distribution.

Hepatic cancer in Chinese: a chapter in "georgraphic pathology".

Chinese patients display an unsually high incidience of hepatocellular carcinoma, as expressed in autopsy statistics, in hepatic biopsy specimens, in terms of ratios per 100,000 population, and with regard to standarized mortality rates. As in other ethnic groups, Chinese hepatoma patients show a pronounced numerical preponderance of male over female persons. Whether this sex difference is due to the existnece of cross-reactivity between HBsAg and a male-associated antigen remains to be confirmed. Of the Chinese patients residing abroad, those that were born in China (Idai) are at considerably higher risk of developing hepatic cancer than those born in their countries of residence (Erdai). This observation, per se, strongly argues in favor of an environmental, rather than racial, factor in the causation of such tumors. Among environmental factors suspected of contributing towards the observed inter-ethnic differences in hepatoma incidence rates, parasitic infestations appear to play no role in hepatocarcinogenesis, with the possible exception of clonorchiasis which has been implicated in cholangiocellular carcinomas. Dietary factors, hepatotoxins and alcoholism at beast are of only secondary etiological significance. Cirrhosis has been considered the most important etiological factor in the development of hepatocellular neoplasms. In Chinese patients the proportion of hepatomas arising in cirrhotic livers in many times higher than in Caucasian persons. Surveys have shown that the hepatitis-associated antigen has a high incidence of occurrence in persons of Chinese ancestry, especially those that were born in China, as well as in patients with hepatomas. It has been established that Chinese-Americans are at a very high risk for both hepatitis B virus infection and liver cell carcinoma. In addition, it has been hypothesized that in some families children will be infected with the virus by their mothers during the perinatal period, and that in some cases the infected person swill proceed through several stages (carrier state with retentions of antigen; development of chronic hepatitis; elaboration of cirrhosisis) to the development of hepatocellular carcinoma. It appears, then, that infection with the hepatitis B virus, during the earlier phases of life, is the single most important event in the eventual elaboration of hepatocellular carcinoma. The available epidemioligcal data on Chinese patients constitute a significant body of evidence in support of these conclusions.

Epidemiology of cancer of the stomach.

AbstractThe epidemiologic study of cancer is based primarily on mortality, morbidity, clinical, and autopsy statistics. The analysis of the results of a mass survey examination of the stomach has contributed considerably to the epidemiologic study of gastric cancer. We present a survey of the literature on stomach cancer mortality and incidence in relation to geography, age, sex, race, and environment. Thereupon, we offer the results and evaluate the effects of a mass survey examination of the stomach which was begun in 1960 in Miyagi Prefecture, Japan. It is to be noted that the mortality rate from stomach cancer per 10,000 persons per year in the nonexamined group was approximately 2.4 times higher than that of the examined group.

Diet and cholesterol gallstones. A multicenter study.

In France, changes in the incidence of gallstones during the 20 years following World War II paralleled the changes in total calories, protein and lipid of the diet. The incidence of gallstones in autopsy statistics has been compared to the diets in different countries: France, India, Japan, Portugal, South Africa, Sweden and Uganda. Low calorie, low protein, low lipid intake and vegetable diet are associated with a low incidence of gallstones. A positive correlation between calorie intake and gallstones incidence was found at necropsy for calorie intakes lower than 3,000 kcal. In countries with high calorie, high protein and high lipid intakes, such a correlation was not found. These results suggest that a hypocaloric diet associated with a low intake of fat and protein mostly of vegetable origin, is protective against cholelithiasis.

Schistosomiasis as a worldwide problem: pathology.

Low-grade schistosome infection is often well tolerated, except for the danger of ectopic lesions; the risk of life-threatening pathology increases with rising worm burdens. At present, quantitative stool or urine egg counts do not reliably measure individual infection intensity, especially in adult patients, and more precise methods are needed on which to base therapeutic decisions. Timely schistosomicidal treatment will prevent or improve bilharzial lesions, often dramatically, but can not reverse established liver pipe stem fibrosis. Pathological studies in Ibadan and Cairo have shown that in schistosomiasis haematobia the frequency of obstructive uropathy increases in relation to the egg load in urinary tissues. Obstruction, in turn, predisposes to bacterial superinfection and is a significant cause of renal failure and death in highly endemic populations. Urinary bilharzial lesions are most active in the young and tend to become inactive in older patients. Urinary tissue egg burdens first rise, plateau, and ultimately decrease with age, most sharply after the fifth decade. The relationship between tissue egg burden and 24-hr urinary egg output varies according to stage of activity, while the severity of disease depends on egg burden regardless of stage. Therefore, during the inactive stage, severe pathology can coexist with a minimal urinary egg output. Both clinical and autopsy statistics show a correlation between the frequency and the intensity of bilharzial infection. Most of the severe pathology occurs in population groups with an autopsy frequency above a threshold of 30%. The clinical and epidemiological implications of these findings are discussed.

An Epidemiological Study on Cancer of the Esophagus

Only little difference was observed between age specific incidence rate and death rate for ca. esophagus in Japan. This tendency was more striking in males than in females. Far lower sex ratio was noted for cancer of upper 1/3 of esophagus than that for middle 1/3 and lower 1/3 of esophagus in mortality statistics (1958-67), in mortality statistics (1958) and in autopsy statistics (1966-67) for all Japan. Sex ratio was also found to be lower in ca. esophagus of younger age groups. Two endemic areas were noted in Japan; (1) Souther Tohoku to Nouther Kanto and (2) Nara, Wakayama Districts. Sex ratio was noted to be much lower and almost stable for more than 7 years in latter case.Stimulated by this fact, a world map was made according to the endemicity and sex ratio of cancer of the esophagus. A Type B Type C Type It is of interest that the extent of geographical aggeregation by county unit is much higher in Type A than in Type B or C.A combined effect of daily drinking and smoking was clearly noted on the risk of ca. esophagus. by both retrospective studies and prospective studies. A among non daily drinkers annual death rate was 4.2-7.6 per 100, 000 compared to 27.9 among daily drinkers who also smoke over 20 cigarettes daily (Prospective study for 265, 118). Drinking habit of hot tea and deficiency of citrus fruits, milk, green yeallow vegetables were also noted as possible risk factors. These must be more important in Typpe A endemic areas.

Congenital absence of the gallbladder.

Congenital absence of the gallbladder is a rare anomaly of the biliary tract. Recently, three additional patients were seen at the Lahey Clinic within a few months of each other. The approximate incidence of this anomaly, derived from autopsy statistics reported by Monroe and Ragen, 1 was 0.09 per cent (33 instances in a series of 35,626 necropsies). The reported incidence in children is 0.37 per cent, however, considerably higher than the over-all incidence, and in keeping with the higher incidence of all congenital anomalies in children. The anomaly is observed at necropsy about equally in both sexes. Clinically, it is observed about twice as often in females as in males, which is in accord with the usual sex ratio in surgical disease of the biliary tract —that is, the anomaly apparently occurs as often in men as in women, but disease of the biliary tract requiring operation is found