Autopsy Table Research Articles

Adventitial Inflammation of the Coronary Arteries in Patients, with and without Diabetes Mellitus, Who Died of Acute Coronary Disease: A Reliable Marker of Active, Progressive, Atherosclerotic Disease

Background: Atherosclerosis is a progressive, chronic inflammatory disease, but it is not yet possible to identify specific plaques with active, progressive, disease. Adventitial inflammation (AI) is a component of the chronic inflammatory response and may be useful in identifying the actively growing, vulnerable plaque, with impending disruption. Methods: The hearts of 61 patients who died of acute coronary disease (ACD), 18 diabetic and 43 non-diabetic, and 22 control patients were obtained fresh and uncut at the autopsy table. The coronary arteries were injected with a colored barium-gelatin mass and the heart fixed in formalin. After fixation, the coronary arteries were dissected intact, decalcified, cut at 2-3 mm intervals, and all segments mounted for microscopic study to determine the frequency of AI and its relationship to the overall plaque burden (PB), the PB in the proximal and distal segments of each coronary artery, and all plaque disruptions (PD). Results: AI was present in 50% of 5,466 coronary segments in these 61 patients compared to 16% in the control patients. Patients with diabetes had a greater PB, P=<0.02, and more extensive AI than non-diabetics, p<0.001, in both proximal and distal segments. There was a direct relationship between PB and AI in both diabetic and nondiabetic patients, but was significantly greater in diabetic patients, p=<0.001. Multiple PD’s, 148, were present in these 61 patients and 95% were associated with AI, but there was no significant difference in the frequency of PD’s in diabetic compared to non-diabetic patients. Conclusions: AI appears to be a reliable histologic marker of active, progressive, atherosclerotic disease and may be helpful in identifying the vulnerable plaque with impending disruption. Diabetes accelerates atherosclerotic disease, but does not accelerate PD.

Phulmoni's body: the autopsy, the inquest and the humanitarian narrative on child rape in India

This article provides a close reading of the circulation of the case of the ‘child-wife’ Phulmoni Dasi, which is acknowledged to have triggered the Age of Consent Act of 1891. Instead of assuming that the evidence of corporeal trauma triggered the various responses to the problem of child marriage – reformist or reactionary – that have been comprehensively documented by historians, this article scrutinizes the unfolding of a humanitarian narrative that reconstituted child marriage as a socio-medical problem that was discovered, diagnosed and administered, through an unprecedented focus on the body. By foregrounding the formal unity of the autopsy, the inquest and the humanitarian narrative, this article draws attention to the striking investment in the corpse as the repository of truth about crime, culture, pain and compassion, on the one hand, and the obfuscation of the bodily detail in the dissemination of this particular case from the autopsy table to the courtroom and to the public discourse on child marriage, on the other hand. By comparing and contrasting two narratives that rested on the child-wife's body – a colonial medico-legal discourse that served to render the culturally common crime of rape into the uncommon crime of culture through a focus on the rape of children, and a seemingly universal humanitarian narrative that rested on a common compassionate response to sexual violence against the child, this article highlights the colonial genealogy of modern humanitarianism. This article thus queries the centrality of the body in the humanitarian narrative in order to interrogate the racialized underbelly of modern humanitarianism.

Dissection of Patricia Cornwell's feminist woman detective Kay Scarpetta

This analysis of Kay Scarpetta acknowledges the importance of feminism in the identity of this woman detective. Kay Scarpetta contests patriarchy from the root: she is a forensic anthropologist with the necessary intellectual abilities and expertise for the pursuit of criminals. She has the power to solve the murder, the patriarchal privilege enjoyed by the traditional male detective, but her characterisation retains feminine characteristics, too: she can admit to be afraid in the face of danger and she cares for victims, those lying on her autopsy table – many of whom are women – but also the ones left behind. Kay Scarpetta’s identity leads her to expose the forms that women’s victimisation can take in a society based on prioritising men’s privileges. The obstacles that Kay Scarpetta has to overcome in order to expose patriarchy will not discourage her, though, since her ultimate goal is to help dignity and equality prevail.

Phantoms in the mortuary—DNA transfer during autopsies

DNA evidence frequently plays an important role in criminal investigations and in some cases may be the only means of convicting a suspect. The constant improvement of DNA analysis techniques affords the individualization of minute amounts of DNA, aggravating the risk of contamination artifacts. In our study, we investigated the prevalence of DNA contamination in the autopsy facilities of the Institutes of Legal Medicine in Essen and Kiel (Germany). Using DNA-free swabs, we took samples from instruments used during autopsy and autopsy tables. Surfaces and instruments were routinely cleaned before sampling. Swabs were subjected to different PCRs to quantify the total amount of DNA and to amplify individual specific STR-markers. In most samples, alleles that could be linked to bodies that had been autopsied before were found. Furthermore, we could show that a DNA transfer from the autopsy table to a body was detectable in four out of six cases investigated. The interpretation of DNA typing results may thus be severely complicated. To avoid DNA contamination, we tried out different cleaning methods, of which only a bleach containing cleaner showed sufficient results.

Invited Commentary

Although many consider intramural hematoma (IMH) to be a variant of aortic dissection, the pathogenesis still remains unclear. First described by Krukenberg [1Krukenberg E. Beitrage zu frage des aneurysma dissecans.Beitr Pathol Anat Allg Pathol. 1920; 67: 329-351Google Scholar] in 1920, IMH is defined as bleeding into the outer layers of the aortic media from rupture of the vasa-vasorum without a primary intimal tear. Despite the increased in vivo recognition of IMH, an aura of uncertainty and mystery surrounds this clinical entity [2Evangelista A. Mukherjee D. Mehta R.H. et al.Acute intramural hematoma of the aorta: a mystery in evolution.Circulation. 2005; 111: 1063-1070Crossref PubMed Scopus (360) Google Scholar]. However, this confusion should not involve the definition of IMH, which is clear and unambiguous. In recent years, powerful vascular imaging techniques demonstrated a wide spectrum of lesions associated to medial blood extravasation in vivo. These images have created in our literature ambiguity between the “classical” definition of IMH (based on autopsy series) and an IMH that may accompany other conditions, such as penetrating aortic ulcers (PAU) or aortic dissections (ie, noncommunicating aortic dissections). The need to re-define traditional clinical concepts in light of modernimaging techniques led Ganaha and colleagues [3Ganaha F. Miller D.C. Sugimoto K. et al.Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis.Circulation. 2002; 106: 342-348Crossref PubMed Scopus (376) Google Scholar] to introduce a separation of aortic IMHs into those with or without penetrating atherosclerotic ulcers. At the moment, there is a lack of agreement in the definition of IMH and PAU; therefore, a new consensus regarding definitions is needed. These definitions should always be clear and functional; therefore, wringing new meaning out of old words is only justifiable if it contributes to better understanding. This article by Grimm and colleagues [4Grimm M. Loewe C. Gottardi R. et al.Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta.Ann Thorac Surg. 2008; 86: 453-457Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar] is an example of the deleterious consequences of our current confusion. The article describes interesting observations regarding the relationships between the localization of plaques within the aortic arch, and progression of the IMH. However, it is clear that these patients do not have “classical” IMHs. This ambiguity raises the possibility of an endovascular option for IMHs, but these lesions are not IMHs and penetrating aortic ulcers are already treated by endovascular means [5Svensson L.G. Kouchoukos N.T. Miller D.C. et al.Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg. 2008; 85: S1-S41Abstract Full Text Full Text PDF PubMed Scopus (682) Google Scholar]. This unfortunate use of terms transforms this honest, although limited, series of PAUs treated by stent grafts, into something different. The result is deceiving and puzzling but urges all of us to reflect; should we preserve a trustworthy definition born on the autopsy table almost 90 years ago or adopt new definitions based on radiologic images? Novel Insights Into the Mechanisms and Treatment of Intramural Hematoma Affecting the Entire Thoracic AortaThe Annals of Thoracic SurgeryVol. 86Issue 2PreviewThe purpose of this study was to address a previously not described mechanism underlying intramural hematoma (IMH) of the entire thoracic aorta and to test the hypothesis whether endovascular stent graft placement in this particular mechanism could be beneficial. Full-Text PDF

Can Recent Theory of New Lymph Vessel Formation Called Lymphangiogenesis Resolve the Controversial Status of the Krukenberg Tumour

HYPOTHESIS: It is held that Krukenberg tumours represent bilateral ovarian involvement from particular growths especially stomach cancers. Hitherto, the route of spread had been controversial. However, on the basis of both animal experimental research and human autopsy work as well as the new frontier in lymph vessel staining techniques, it is hypothesized that the formation of new lymph channels, called lymphangiogenesis, sufficiently explains the peculiar relationship between stomach primaries and ovarian (Krukenberg) secondaries. Furthermore, this conclusion can be tested (a) by strictly avoiding the old fashioned separation of these two organs on the autopsy table and (b) by carefully choosing composite stomach-ovary blocks, staining them appositely, and confirming whether lymph vessels constitute the transportation routes. . Keywords : Krukenberg tumours, ovarian selectivity, theories of spread Journal of College of Medicine Vol. 13 (2) 2008: pp. 62-64

Forensic implications of Attention Deficit Hyperactivity Disorder

Forensic implications of Attention Deficit Hyperactivity Disorder - ADHD. ADHD represents one of the most frequently met conduct disorder in children and teen-agers. The present article is an overview of ADHD studies that also touch the forensic medicine domain. The results of these studies show that a major percent of ADHD patients as long as their victim’s become cases for forensic services, on the autopsy table and in different types of living person expertise (traumatological, psychiatric, toxicologic expertise). We consider that different aspects that characterize this disorder represent a scientific domain not sufficiently explored yet by forensic specialists.

Abject d’Art

Central to the embalmer’s and mortician’s art is an interesting paradox- the signification of death without physical corruption of the body. Howarth’s analysis of the “humanization techniques” in sustaining the fiction of living, points not only to “theatrical strategies” involved, but to the necessary concealment of the artist (the embalmer, the undertaker) in the process.

The Pathophysiology of Migraine

Curtis P. Schreiber, MD igraine is the most common of all neurologic disorders, but the exact echanism of the process remains elusive. Perhaps the fact that migraine s an intermittent process that does not often render its sufferer as a pecimen on the table of the pathologist is one of the reasons that greater dvances have not been made. The fact that the migraine sufferer, even hen arriving at the autopsy table, reveals no traces of the pathologic isturbance (at least as assessed by conventional measures) may be nother reason for the lack of definition of the process of migraine. erhaps the real issue is that migraine is not a “disease” in the classical ense of the word but represents a normal pathophysiologic mechanism hat is activated more often and more intensely in those who suffer with he recurrent clinical experience that we have termed migraine. Because migraine is clinically defined based on the occurrence of ecurrent episodes of neurologic dysfunction, most commonly associated ith headache, it remains speculative to term this condition as a disease. or the reader who experiences migraine or happens to live with a igraineur, the phenomenon is well known, and the recognition of this linical entity is simple. However, for the reader who has never had a real migraine,” I ask you to reflect on your own personal encounters with eadache. Think about having a significant febrile illness (eg, the flu). ecall the headache that you had that was severe and at times throbbing nd how you had photophobia, nausea, and pounding pain with moveent. Others may have had similar experiences after having a blow to the ead or perhaps after overindulging in alcohol. I postulate that nearly all nonmigraineurs” reading this article have experienced a headache that, hen analyzed by using the standard definition of a migraine attack, is at east “migrainous” in character, if not full-blown, by symptom definition. ecause these attacks may have been few in number and were related to n associated medical condition or other event, you would not be iagnosed as a migraineur, but your nervous system was pushed into the athophysiologic state that migraineurs experience without apparent rovocation on a frequent basis.

Unusual High Exposure to Ultraviolet‐C Radiation

UV radiation is known to cause acute and chronic eye and skin damage. The present case report describes a 90 min accidental exposure to UV-C radiation of 26 medical school students. Germicidal lamps were lit due to a malfunctioning of the timer system. Several hours after irradiation exposure, all subjects reported the onset of ocular symptoms, subsequently diagnosed as photokeratitis, and skin damage to the face, scalp and neck. While the ocular symptoms lasted 2-4 days, the sunburn-like condition produced significant erythema followed by deep skin exfoliation. The irradiation was calculated to be approximately 700 mJ cm(-2) absorbed energy, whereas the actual radiation emitted by the lamps was 0.14 mW cm(-2) (the radiometric measurements confirmed these calculi, because the effective irradiance measured from the height of the autopsy table to about 1 m under the UV-C lamp varied from 0.05 to 0.25 mW cm(-2)) but, more likely, the effective irradiance, according to skin phototype and symptoms, was between 50 and 100 mJ cm(-2). The ocular and skin effects produced by such a high irradiation (largely higher than that accepted by the American Conference of Governmental Industrial Hygienists [ACGIH] threshold limit values [TLVs]) appeared reversible in a relatively short time.

Heart Attacks, Heart Rate, and Gel Electrodes: the invention of ambulatory cardiology

Ambulatory cardiology began in 1959 in a department of pathology to answer a question raised at the autopsy table: are high heart rates in apparently healthy individuals a risk factor for developing coronary artery disease? This question led to the development of a miniature monitor and a new kind of electrode, which enabled clinicians to measure EKG signals during activity and over prolonged periods of time. These electrodes are now used universally for diagnosis and for monitoring the heart during a myriad of different activities and circumstances. The story of the development of the monitor and electrodes illustrates the ways in which ideas and discovery lead to applications and advances in medicine.

The Challenges Facing Neurology, Neurosurgery, and the Neurosciences

Neurology as a distinct specialty is relatively new in the history of medicine. Beginning with Charcot, who built his neurology on a firm phenomenologic basis, the specialty of neurology was developed rapidly by such outstanding clinicians as Babinski, Duchenne, Erb, Marie, and Hughlings Jackson. In the 19th century, clinical observations increasingly were linked to neuroanatomical substrates. At the turn of the century, neuropathology gained a foothold, and clinical methods were developed further by such luminaries as Ramon y Cajal. Primitive laboratory procedures began to relate spinal fluid and brain electrical changes to human disease. A cadre of superb clinicians emerged, and neurology departments began to appear at medical schools, where residents were taught to interpret signs and symptoms carefully at the bedside. Mentored by superb clinicians, but lacking definitive laboratory and imaging procedures, these young neurologists continued the tradition of a specialty renowned for deductive reasoning. Neurologists were able to predict things other physicians could not, often with startling accuracy. But the specialty was plagued by lack of definitive studies to confirm clinical impressions, and an even more pervasive paucity of treatments for most neurologic conditions which exacted such a heavy human toll. Crude laboratory and radiologic tests, including angiography, were the only tools available. The clinicopathologic conference was in its heyday, and unexpected and startling revelations frequently were made at the autopsy table.

Paediatric Cardiology, 2nd edition, volumes 1 and 2

Robert H. Anderson, Edward J. Baker, Fergus J. McCartney, et al, eds. 1036 pp (vol 1) and 1036 pp (vol 2). London: Churchill Livingstone; 2002. $399.00. ISBN: 0-4430-7990-0 A long-awaited second edition of Paediatric Cardiology has finally been published, after a period of 15 years. The chief editor, Robert Anderson, is one of the founding fathers of the field of cardiac morphology. The second edition has retained much of its original focus on cardiac morphology, laying out the “heart” of the subject, as it were. Its persisting emphasis on the importance of understanding the morphology of congenital heart disease (CHD) comes from having retained most of the primary authors and many more of the illustrations from the first edition. Indeed, improving non-invasive imaging technology has shifted the illustration of anatomy questions from the autopsy table to the echo laboratory. The new …

The Postmodern Educator. Arts-Based Inquiries and Teacher Development

Book Review The Postmodern Educator. Arts-based Inquiries and Teacher Development Diamond, Patrick and Mullen, Carol. (Eds.) 1999. New York: Peter Lang. 466 pages. ISBN 0820441015 (paperback) Educational Research in Transition Take a strip of paper and join its both ends so that you wind one end upside down before fixing it together with the other. You have constructed the central metaphor of Diamond and Mullen's book The Postmodern Educator, the double-faced Mobius strip that symbolizes the dualistic and endless movement of artistic knowing. Learning is constructing a threedimensional spiral: moving to the beginning of a new cycle on the other side of the strip and changing the point of view. The editors of this book, flooded with metaphors, describe themselves as educator detectives around the autopsy table questioning the tradition of empirical research and creating new methodology. They are accompanied by phenomenological humanists, subjective particularists, representatives of critical theory, poststructuralists, contextualists, constructivists, narrativists, postmodernists, and arts-based inquirers. Their aim is not to bring heretics to trial or to detect the causes of a crime but to understand the situation. To proceed in the metaphoric line of the editors, the book is about composing new melodies, about a journey along a slippery lakeshore, in labyrinths, galleries, stairways... The conceptual keys of the research then become narrativity, experiential inquiry, participation, openness, and pluralism. Instead of promoting the enlightenment story of progress, the authors prefer open-ended and contradictory texts, networks and complexity in posing questions. The book comes out in a time of fracture and transition in educational research and in society at large. It is a contribution to the discourse on the paradigm change, and it reflects upon the effects of the postmodern state of teacher education and scholarly work. The editors characterize their standpoint to postmodernism as reaching for something that does not yet exist. On the other hand, they consider their book a palimpsest, like parchment bearing traces of several layers of revised texts. From the intertextual point of view, there is nothing new in the book; it leans on the works of others, as in pastiche. The task of reviewing the book came to me in the middle of intensive debate on the nature of the so-called artistic research in Finnish art colleges. Are our communities of arts and education prepared to carry out postmodern demands for change: Could a dissertation be a poem, a performance, or a painting? My position in the debate is that of a Finnish art teacher educator and a researcher whose postgraduate studies included 2 years in the United States. I decided to write my review according to the methods of the authors, i.e. through listening to the contradictory voices it provoked in myself. Teacher Researcher as Artist The authors are socially active educational researchers and their main goal is integrating arts into research. Awareness of both this premise as well as the backgrounds of the authors is worth noticing to understand the book. Most of the chapters are written by the editors, Australian born Patrick Diamond and his former student Carol Mullen who is nowadays working in the USA. The book is largely based on Professor Diamond's research classes at the University of Toronto in Canada. The other authors are five professors, one kindergarten teacher, four high school teachers, and a puppeteer. They hail from the USA, Australia, and Canada. One of the education professors is the only writer who has studied any visual arts. The editors emphasize the nature of art as a representation of reality. Unlike in correspondence theory, everything we know is transformed by language and power structures. The quality of experience often emerges only after being represented in artful form. …

1] Staining methods for identification of amyloid in tissue

The staining reaction given by amyloid after treatment with iodine was often used in the earlier studies of amyloidosis, and amyloid is still identified by its characteristic histological staining reactions. Despite the enormous amount of knowledge now known regarding the molecular nature of amyloid, histological staining methods are crucial for the diagnosis of amyloidosis and are also used commonly in amyloid research. Also, the introduction of modern immunohistochemical techniques has made it possible to identify normal and abnormal components in tissue. Immunohistochemistry (often used interchangeably with immunocytochemistry) has become an important tool in amyloid research. Amyloid was first recognized by its tinctorial properties, which were elicited when amyloid-laden tissues were treated with iodine at the autopsy table. This reaction is now known to depend on the presence of minor carbohydrate components in the amyloid deposits. Iodine reacts with the amyloid, giving it a mahogany-like color that changes to blue when sulfuric acid is subsequently added. The staining properties of amyloid with rosaniline dyes (e.g., methyl violet and cresyl violet), which were the main staining methods for amyloid before Congo red staining was introduced in the 1920s, are also based on the presence of these same carbohydrate components. Because of their low sensitivity and lack of specificity, these methods are not commonly used any longer. Most, if not all, dyes used for the identification of amyloid are compounds developed for use by the textile industry. This includes the dye Congo red, which was introduced as the first direct cotton dye in 1884. Much of the background knowledge regarding the properties of these amyloid-associated dyes comes from textile staining.

Differences in Sacral Angulation and Lumbosacral Curvature in Black and White Young Men and Women

The angle between the base of the sacrum and its pelvic surface (SA), and the lumbosacral curve (LSC) defined as the anteroposterior distance between the L₁ vertebra and the sacrum were studied in 105 fresh cadavers aged 15–32 years at death. The sample is comprised of 27 black males, 20 black females, 37 white males and 21 white females. Measurements of the SA were made with an adjustable protractor with an accuracy of ±1°. A new method using a specially designed instrument was developed for taking LSC measurements. A sliding scale that could be moved in the cranialcaudal direction was fitted with a measurement stick which measured the depth of the lumbar and sacral vertebral bodies (ventral to dorsal). The measuring device was placed on the autopsy table above the supine cadaver to measure these depths from the ventral side. The LSC was calculated as the mean difference between lumbar and sacral depths. The SA is smaller in black than in white men (43.6 ± 3.4 vs. 61.7 ± 2.1°, p <0.001). Similarly, black women have a smaller SA than white women (36.0 ± 2.2 vs. 50.2 ± 1.9°, p <0.001). The LSC is also larger in black than white men (9.4 ± 1.1 vs. 5.1 ± 0.3 cm, p <0.001), and black women also have significantly larger LSC compared to white women (13.2 ± 0.5 vs. 9.2 ± 0.6 cm, p <0.001). These data are so far the largest empirical evidence of differences in the SA and the LSC in young black and white cadaver specimens.

Bone-dust in autopsies: Reduction of spreading

During autopsies, an open oscillating saw produces large quantities of respirable bonedust, which is able to carry microbes over several metres. Experiments were done using a modified (open) undulation saw (spray tube to moisten the saw-blade with water). Saw-dust was asservated with culture media. Colonies were identified macroscopically. Microbes in the air were quantified (per unit of time). A remarkable reduction of saw-dust is done by an integrated spray tube using water. There remains a contamination at the head of the autopsy table in the level of the table-top. We found a complete decontamination 150 cm above the floor. No spreading of particles carrying microbes was seen over distances of more than 1.5 m. The risk of an airborne infection is minimal when using a manual saw (absence of grinding-dust). The modified type of an ‘oscillating saw with a spray-tube’ may be considered a practicable compromise between a manual saw and an unprotected undulation saw. It is necessary to complete the precautions against airborne infections by breath masks and safety-goggles.

Death Certificate Completion by Physicians

To the Editor. —Surely Drs Messite and Stellman1are jesting when they suggest a new medical school course in how to fill out certificate forms. Fifty years ago when I began medical school, the department of medicine taught me the etiology, sequences, and sequelae of diseases, and the department of pathology demonstrated this graphically at the autopsy table. Even though autopsy rates are not as high today as 50 years ago, I assume the modern-day medical student does spend some time at the side of the autopsy table and does read autopsy reports, which by tradition and protocol are finalized with cause of death written in the same manner as is required on most certificates. I also assume that clinical pathological conferences and morbidity and mortality conferences are attended at many teaching hospitals. In these educational conferences, the diagnosis is arrived at by the process of medical

Child Abuse: Medical Diagnosis and Management

This handsome book of moderate size brings together material on a subject that is vital in the culture of today. One can hardly escape the subject of child abuse, which is presented by all types of media, sometimes luridly and sensationally. The 26 contributors have approached child abuse in general and by location of trauma, eg, head, trunk, skeleton, and even the body at the autopsy table. In some states, physicians and others are required by law to report suspected child abuse. Therefore, an especially valuable chapter is entitled Conditions Mistaken for Child Abuse. One rarely thinks of poisoning as a form of abuse, but, surprisingly, a chapter on poisoning as child abuse has 143 references. References in all chapters are impressive, as illustrated by 256 for the chapter Sudden Infant Death and Child Abuse. Many of the chapters have superior illustrations. Those comparing female genital trauma with congenital or

X-linked lymphoproliferative disease.

The disease discussed in this chapter was discovered 30 yr ago at the autopsy table by a young and very inquisitive pathologist. Within the past year, the mutated gene central to this condition has been cloned and studies are underway to elucidate its normal immunologic function. This review summarizes our present state of knowledge of X-linked lymphoproliferative disease (XLP).