Consent For Autopsy Research Articles

Self-Rated Competence of Ugandan Healthcare Workers to Obtain Informed Consent for Autopsy.

We examined the self-rated competence of Ugandan healthcare workers (HCWs) in obtaining informed consent for autopsies, considering the challenges of low autopsy acceptance rates globally. In September and October 2023, we conducted a nationwide cross-sectional study of HCWs, who provided informed consent to participate and completed an online, self-administered questionnaire. Participants' self-rated competence in obtaining informed consent for autopsy was assessed through Likert scale questions. Knowledge and practices were also assessed. All scores were converted to percentages, with scores ≥80% indicating higher competence. We enrolled 216 HCWs (including 145 [67.1%] doctors), with a mean age of 31.6 ± 7.2 years. Overall, 55.6% (n = 120) had ever assisted in obtaining consent for autopsy, 43.6% (n = 100) had ever obtained consent for autopsy themselves, and 13.4% (n = 29) had ever attended training on obtaining consent for autopsy. The mean competency score was 59.8 ± 17.0% (perfect score, 100%), with 29 (13.4%) participants demonstrating high competence. Healthcare workers with adequate knowledge had higher competence scores (odds ratio [OR]: 15.0, 95% CI: 6.17-36.58, P <0.001). Compared with nurses/midwives, doctors had 73% lower odds of having a high competence score (adjusted OR: 0.27, 95% CI: 0.08-0.94, P = 0.040). Fewer than one in five Ugandan HCWs demonstrated high self-rated competence or possessed adequate knowledge regarding informed consent for autopsies, and only a few had received specialized training on how to obtain consent for an autopsy. Therefore, there is a pressing need for enhanced training and increased awareness among Ugandan HCWs in obtaining informed consent for autopsies.

Obstructive or non-obstructive megacystis: a prenatal dilemma.

Diagnosis of prenatal megacystis has a significant impact on the pregnancy, as it can have severe adverse effects on fetal and neonatal survival and renal and pulmonary function. The study aims to investigate the natural history of fetal megacystis, to try to differentiate in utero congenital lower urinary tract obstruction (LUTO) from non-obstructive megacystis, and, possibly, to predict postnatal outcome. A retrospective single-center observational study was conducted from July 2015 to November 2023. The inclusion criteria were a longitudinal bladder diameter (LBD) >7 mm in the first trimester or an overdistended/thickened-walled bladder failing to empty in the second and third trimesters. Close ultrasound follow-up, multidisciplinary prenatal counseling, and invasive and non-invasive genetic tests were offered. Informed consent for fetal autopsy was obtained in cases of termination of pregnancy or intrauterine fetal demise (IUFD). Following birth, neonates were followed up at the same center. Patients were stratified based on diagnosis: LUTO (G1), urogenital anomalies other than LUTO ("non-LUTO") (G2), and normal urinary tract (G3). This study included 27 fetuses, of whom 26 were males. Megacystis was diagnosed during the second and third trimesters in 92% of the fetuses. Of the 27 fetuses, 3 (11.1%) underwent an abortion, and 1 had IUFD. Twenty-three newborns were live births (85%) at a mean gestational age (GA) of 34 ± 2 weeks. Two patients (neonates) died postnatally due to severe associated malformations. Several prenatal parameters were evaluated to differentiate patients with LUTO from those with non-LUTO, including the severity of upper tract dilatation, keyhole sign, oligohydramnios, LBD, and GA at diagnosis. However, none proved predictive of the postnatal diagnosis. Similarly, none of the prenatal parameters evaluated were predictive of postnatal renal function. The diagnosis of megacystis in the second and third trimesters was associated with live births in up to 85% of cases, with LUTO identified as the main cause of fetal megacystis. This potentially more favorable outcome, compared to the majority reported in literature, should be taken into account in prenatal counseling. Megacystis is an often misinterpreted antennal sign that may hide a wide range of diagnoses with different prognoses, beyond an increased risk of adverse renal and respiratory outcomes.

Development of A Micro-CT Scanner with Dual-Energy Option and Endovascular Contrast Agent Administration Protocol for Fetal and Neonatal Virtual Autopsy.

The rate of parental consent for fetal and perinatal autopsy is decreasing, whereas parents are more likely to agree to virtual autopsy by non-invasive imaging methods. Fetal and perinatal virtual autopsy needs high-resolution and good soft-tissue contrast for investigation of the cause of death and underlying trauma or pathology in fetuses and stillborn infants. This is offered by micro-computed tomography (CT), as opposed to the limited resolution provided by clinical CT scanners, and this is one of the most promising tools for non-invasive perinatal postmortem imaging. We developed and optimized a micro-CT scanner with a dual-energy imaging option. It is dedicated to post-mortem CT angiography and virtual autopsy of fetuses and stillborn infants in that the chamber can be cooled down to around 5 °C; this increases tissue rigidity and slows decomposition of the native specimen. This, together with the dedicated gantry-based architecture, attempts to reduce potential motion artifacts. The developed methodology is based on prior endovascular injection of a BaSO4-based contrast agent. We explain the design choices and considerations for this scanner prototype. We give details of the treatment of the optimization of the dual-energy and virtual mono-energetic imaging option that has been based on minimizing noise propagation and maximizing the contrast-to-noise ratio for vascular features. We demonstrate the scanner capabilities with proof-of-concept experiments on phantoms and stillborn piglets.

The Role of Forensic Autopsy in Pursuit of Material Truth in Optical Evidence for Negative Legal Proof in the Cyanide Coffee Murder Case

Conducting criminal investigations in Murder cases sometimes faces challenges in obtaining the family's consent for the victim's autopsy. This difficulty arises due to issues related to the victim's religious beliefs, which prohibit the autopsy of murder victims. The autopsy process by the investigative authorities encounters internal obstacles due to limited government funding for the autopsy process. The problem in this research is that, since no autopsy was conducted on Mirna's body, the cause of death remains unknown to establish material truth. The police can compel an autopsy based on Article 134, paragraph (1) of the Criminal Procedure Code, which includes the phrase "when it is highly necessary, and for the purpose of proving, a body autopsy cannot be avoided." Looking at this phrase, whether an autopsy is performed on murder victims is within the investigator's authority and based on the investigator's subjective considerations.

Unveiling Opinions: Exploring the Public’s View on Clinical Autopsies

Background: Clinical autopsy is an invaluable tool useful to identify causes of death and to uncover unknown and unexpected diseases which aids in raising awareness of common and rare diseases in a community. Clinical autopsy is essential to study pattern of morbid diseases that aids in formation of effective healthcare policies. Aim: To investigate the views of the general public on clinical autopsies in order to determine general conceptions and misconceptions that may aid in further a discussion and investigations. Methodology: This prospective cross-sectional study was conducted at Department of Forensic Medicine, Dow International Medical College, Dow University of Health Sciences Karachi Pakistan from October 2022 till March 2023. Data was collected from 300 participants using a 15-item questionnaire distributed to general population from various parts of Karachi selected by convenient sampling. Results: 46% were aware of term clinical/medical autopsy. 77% acknowledged medical and social role of clinical autopsies. Less than 50% could differentiate between clinical and medico legal autopsy. 50% are of the opinion that autopsy should not be conducted in natural deaths. 55% and 64% of the participants were of the opinion that clinical autopsy can improve future lives of people and provide diagnostic and curative strategies respectively. Participants of the study were unsure about the Islamic perspective of autopsy. 57% agreed to give consent for autopsy in society’s best interest. Conclusion: The large majority is uncertain about autopsy given their religious and personal views but it also reveals many acknowledge its possible utility in medicine and in bereavement process. Therefore, despite lack of research and public discourse, it provides us with data that may encourage and aid further research and discussion about acceptance of autopsy as a viable diagnostic tool. Keywords: Autopsy, Clinical autopsy, Medical autopsy, Pakistan

The Adult Changes in Thought (ACT) Medical Records Abstraction Project: A resource for research on the aging brain and Alzheimer’s disease and related dementias

AbstractBackgroundAdult Changes in Thought (ACT) is a prospective cohort study of older adults from Seattle, Washington, USA. Participants are enrolled from Kaiser Permanente Washington membership and may consent for autopsy. Many participants have decades of medical records prior to ACT enrollment. We describe an ambitious project to abstract medical records to facilitate epidemiological investigation.MethodAbstractions include medication data preceding 1977 (the start of automated pharmacy data), laboratory data preceding 1988 (the start of automated laboratory data), women’s health history elements, blood pressures, several cardiovascular conditions, several neurological conditions, physical injuries, psychiatric conditions, and other medical conditions, among many others. Data are entered in a Microsoft Access front‐end interface linked to a Microsoft SQL Server database engine. The database comprises 15 tables in a relational structure. We summarize chart review data and other data according to dementia status.ResultWe have completed abstractions on 1329 individuals, of whom 908 had an autopsy. For the first 380 people with an autopsy, it took an average of 6.2 hours (SD 3.8 hours) to abstract &gt;30 years of medical data. More recent electronic medical record data take longer to abstract. In this sample, 236 (62%) died without Alzheimer’s Disease or Related Dementias (ADRD) dementia, and 144 (38%) died with an ADRD dementia diagnosis. Demographic and clinical data are summarized in the Table. Over 60% had pharmacy data preceding 1977 with a median of more than a half decade’s worth. Over 90% of the cohort had additional laboratory data preceding 1988, with a median of a decade’s worth. Medical conditions were similarly common across people without and with ADRD, except cerebrovascular accidents, diabetes, depression, and confusion during hospitalization were more common among people with dementia. We will update all numbers for AAIC.ConclusionThe ACT Medical Records Abstraction Project transforms medical records into data ready for analyses of associations with outcomes derived from other data from the ACT study. For the autopsy cohort in particular, the Medical Records Abstraction Project provides unmatched detailed longitudinal clinical data to support a wide variety of epidemiological research on clinical‐pathological correlations.

Perinatal autopsy in Ghana: Healthcare workers knowledge and attitude.

Perinatal mortality refers to stillbirths and early neonatal deaths. Stillbirth, the death of a foetus from 28 weeks or with a birth weight below 1,000 g, and early neonatal deaths, the death of a new-born within 24 h of delivery, are among the most distressing global health problems, with approximately 2 million stillbirths occurring annually. Although a post-mortem examination of the stillborn baby is essential for understanding and learning the cause of stillbirth, many couples decline the procedure. Sub-Saharan Africa has one of the highest stillbirth rates in the world, yet there is a dearth of studies on post-mortem uptake from the region. To explore healthcare professionals' views and perceptions of perinatal autopsy in Ghana. Mixed-method approach consisted of semi-structured interviews and an electronic cross-sectional survey to evaluate the views and perceptions of healthcare professionals at Korle-Bu Teaching Hospital on autopsy for stillbirths and early neonatal deaths. Descriptive quantitative data were summarised in frequencies and percentages, and statistical results and descriptions were tabulated and coded in terms of types of barriers. For the qualitative aspect, the audio-taped interviews were transcribed, themes generated, and direct quotes and descriptions were coded for all knowledge, beliefs, attitudes and practices concerning the barriers and facilitators for post-mortem. Ninety-nine healthcare professionals participated. No participant had formal training regarding counselling for perinatal autopsy and 40% had " no idea " who is responsible for counselling and obtaining consent for a perinatal autopsy. Forty-four percent (44%) of the participants knew of only the "Conventional/ Full" autopsy and <4% were aware of less invasive methods of performing an autopsy. Qualitative data showed healthcare worker influence, religious and financial considerations impede the implementation of perinatal autopsies. Despite the low uptake of perinatal autopsies, interviews from healthcare workers suggest acceptance rates would improve if parents knew about different options, especially less invasive procedures. At Ghana's largest referral centre, perinatal autopsy counselling and uptake are at extremely low levels. Most healthcare professionals have little knowledge, skills, and capacity to advise parents regarding perinatal autopsies. Training is needed to update the workforce on recommended perinatal autopsy practices.

O49 - Stillbirth Investigations and Shared Decision Making - Healthcare Professional learning needs

As part of the South Australian Stillbirth Autopsy and Investigations Project (SAIP), a staff survey was conducted across medical, midwifery and Aboriginal maternal infant care workers. The survey asked staff 12 questions focusing on capability, capacity and confidence regarding stillbirth investigations, shared-decision making with parents in regards to autopsy and investigations processes and consent and provision of bereavement care (including awareness of ‘protective parenting’) that underpins these crucial conversations. The staff survey formed a key element in the development of the online education for health care professionals aiming to improve capability, capacity and confidence of staff discussing, consenting, communicating stillbirth investigations process and autopsy for women experiencing a stillbirth. 157 respondents completed the survey. Few staff indicated that they had formal education in counselling bereaved parents. Key learning areas identified included location and use of the Stillbirth Investigations Algorithm, benefits and limitations of autopsy, what is involved in the different types of autopsy and how a baby would look afterwards. Additionally gaps were identified in process knowledge, including transport of babies, time required for autopsy, time before results are ready and funeral home arrangements. The other major learning need that emerged was cultural and/or religious considerations that may impact decision-making, including potential for involvement of cultural or religious leaders and how to approach this with parents. The identification of key learning areas has enabled the creation of a robust education program directly created to meet staff learning needs. Building the capacity, capability and confidence of the staff with stillbirth investigations and shared-decision making will in turn improve the care for parents, facilitate crucial conversations and improve the uptake of stillbirth investigations on a state wide level.

To donate, or not to donate, that is the question: Latino insights into brain donation.

Latinos are underrepresented in brain autopsy research on Alzheimer's disease and related dementias (ADRD). The study's purpose is to identify Latinos' attitudes about brain donation (BD) to inform methods by which researchers can increase autopsy consent. Forty Latinos (mean age: 59.4 years) completed a semi-structured interview and were presented with educational information about BD. Participants completed a questionnaire assessing their understanding of BD and willingness to donate their brain for research. Among participants, there was near unanimous support for BD to study ADRD after hearing educational information. However, prior to the information presented, participants reported a lack of knowledge about BD and demonstrated a possibility that misunderstandings about BD may affect participation. While nearly all study participants agree that donating is beneficial for research and for future generations, the lack of BD information must be addressed to help support positive attitudes and willingness for participation.

Aluminum Phosphide Toxicity

Background: Aluminum phosphides (ALPs) are still being used in developing countries as a pesticide despite the fact that ingestion and/or inhalation can cause significant morbidity and mortality. The generation of phosphine when ALP comes in contact with water leads to the blockade of electron transfer, which inhibits oxidative phosphorylation and in turn, cellular respiration in multiple organ systems. Clinical Description: A 3-year-old Turkish girl and her family were inadvertently exposed to overnight inhalation intoxication after a tablet of ALP was dissolved in water and used as a pesticide for Isot pepper, a local spice used in their household. The child presented with rapidly progressive respiratory distress and coma. The other members displayed mild respiratory symptoms. Management: At the time of admission, she was in altered sensorium, tachycardic, tachypneic, hypoxic, and in shock. She was immediately intubated and intermittent positive pressure ventilation started. Shock was managed as per the standard protocol. The child emanated garlic odor breath, had sluggishly reactive bilateral mitotic pupils. She had cardiorespiratory arrest within 30 min of intubation and could be revived. Despite supportive treatment, multiorgan dysfunction syndrome developed cardiac, pulmonary, renal, hepatic, coagulopathy, hyperglycemia, and metabolic acidosis. She succumbed to another cardiorespiratory arrest before plasmapheresis and continuous renal replacement therapy could be started in an attempt to eliminate the toxins. Consent for autopsy was not given. Conclusions: ALPs poisoning still occurs in developing countries and is a leading cause of mortality. The most common cause of death within the first 24 h is cardiovascular collapse.

The hospital autopsy: the importance in keeping autopsy an option

ABSTRACTAutopsy has been one of the most powerful diagnostic tools in medicine for over a century. Despite its importance in establishing cause of death and elucidating pathophysiology of disease, rates of hospital autopsies continue to decline. In this study we aim to determine if physicians believe autopsies are essential to patient care through discussion of autopsy with families. At the same time, we analyzed whether families are more willing to consent to autopsy if physicians are involved in autopsy discussion at the time of death, and what may be the reasons for not wanting an autopsy. Our results showed a doubling in autopsy consent when autopsy was discussed by the physician. Additionally, the biggest reason for families not consenting to autopsy was because they believed they already knew what caused death. The emergence of Coronavirus 2019 (COVID-19) has re-established the value of autopsy, as seen by increased autopsy rates in the past year. This study demonstrates that physician conversation with families on autopsy leads to an increased chance of autopsy consent.

Perceptions and attitudes of brain donation for Alzheimer’s disease research among older Latinos

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) continue to be highly debilitating, particularly among older Latinos. Latinos are 1.5x more likely to develop ADRD compared to Non‐Hispanic Whites. Even though Latinos comprise 18.5% of the US population, only 8% participate in ADRD research, which is a significant problem given the substantial public health burden of ADRD among this population. Specifically, there is a dearth of brain tissue currently available that is essential for confirming clinical ADRD diagnoses. The purpose of this abstract is to present preliminary findings on a study looking at the perceptions and attitudes related to brain donation (BD) among older Latinos.MethodSemi‐structured phone interviews were conducted over the phone in English or Spanish. Questionnaires were administered to assess demographic characteristics, psychological acculturation, fatalism, and knowledge of aging‐related research relevant to AD. The interview was used to guide participants in the topic of BD and their willingness to BD. All interviews were audio‐recorded and transcribed.ResultParticipants included 40 community‐dwelling Latinos living in the US (Mean age: 59.4, SD=7.35). The majority of participants were female (67.5%) and had an average of 12.55 (SD=3.21) years of education. Most participants were born in Mexico (85%), 10% in the US, and 5% in another Latin American country. Preliminary findings from a subsample of transcripts and the interviewer’s notes indicate some initial but salient themes, including but not limited to 1) lack of information and awareness about BD; 2) key social and cultural factors influencing willingness to donate; and (3) Interviewees’ recommendations for engaging and increasing Latinos BD knowledge and study participation.ConclusionBetter understanding attitudes and perceptions of BD for ADRD research can facilitate targeted culturally‐relevant approaches for increasing autopsy consent that will have a significant and enduring impact on eliminating critical barriers in ADRD for Latinos. Work generated from this study will be used to develop a survey instrument to assess dimensions of diverse Latino willingness to consent to BD research with the goal to increase Latino participation in BD studies that will help address the disparities that exist in this population.

Cause of Death in Patients in Radiation Oncology.

BackgroundThe accurate attribution of death in oncologic patients is a difficult task. The patient’s death is often attributed to his or her underlying cancer and therefore judged as cancer-related. We hypothesized that even though our patient’s cancers were either advanced or metastatic, not all patients had died simply because of their cancer.MethodsA total of 105 patients were included in this retrospective analysis. Patient data were collected from digital and paper-based records. Cause of death was assessed from death certificate and compared to the medical autopsy reports. Discrepancies between premortem and postmortem diagnoses were classified as class I and II discrepancies.ResultsOf 105 patients included, autopsy consent was obtained in 56 cases (53%). Among them, 32 of 56 were palliatively sedated, and 42/56 patients died cancer-related as confirmed by autopsy. The most common cause of death by autopsy report was multiorgan failure followed by a combination of tumor and infection, predominantly lung cancer with pneumonia. Here, 21/56 cases (37%) showed major missed diagnoses: seven cases showed class I, 10 class II, and both discrepancies. The most commonly missed diagnoses in both categories were infections, again mainly pneumonia.ConclusionsCancer was the leading cause of death in our study population. A quarter of the patients, however, did not die due to their advanced or metastatic cancers but of potentially curable causes. We therefore conclude that it is important to consider competing causes of death when treating palliative cancer patients. In a palliative setting, the treatment of a potentially curable complication should be discussed with the patients and their families in a shared decision-making process. From our experience, many patients will decline treatment or even further diagnostics when given the option of best supportive care.

Utilization of clinical autopsy services in a Nigerian teaching hospital

Objectives: The aim of this study was to ascertain the rate of uptake of clinical autopsy services in our hospital and also determine the associated factors. Autopsy is an important part of clinical practice. It serves as an audit and quality control for diagnosis and treatment of diseases. It also provides families with “informed grieving” by giving clearer understanding of the nature of illness and cause of death and may reveal inheritable or communicable diseases among other benefits. Despite these benefits, the rate of autopsy is low and declining globally. Material and Methods: A retrospective study of hospital autopsies performed from January 2013 to December 2017 was carried out. The mortuary and autopsy records of our hospital over the period were retrieved and reviewed. Deaths reported to the police, namely, coroner deaths and deaths before arriving at the hospital (brought in dead, BID) were excluded from the study. Results: A total of 1976 bodies was studied, 1078 males and 898 females (M:F = 1:1.2). Consent for autopsy was sought in 22 (1.1%) cases: 13 (0.66%) from pediatrics, 5 (0.25%) from internal medicine, and the rest from surgery and obstetrics and gynecology. Consent was granted and autopsy performed in 6 (0.3%) cases giving an average of 1.2 autopsies/year. Average hospital stay was 12.6 days and 36.3 days for those consenting to and those declining autopsy, respectively. Consenting persons belong to diverse socioeconomic strata. Conclusion: Autopsy rate is very low in our center. Attending clinicians and relatives of the deceased contribute to this trend. Vigorous education for all stakeholders about the benefits of hospital autopsy is recommended.

Clinical Relevance of Unexpected Findings of Post-Mortem Computed Tomography in Hospitalized Patients: An Observational Study.

Background and objective: The current literature describing the use of minimally invasive autopsy in clinical care is mainly focused on the cause of death. However, the identification of unexpected findings is equally important for the evaluation and improvement of daily clinical care. The purpose of this study was to analyze unexpected post-mortem computed tomography (PMCT) findings of hospitalized patients and assess their clinical relevance. Materials and methods: This observational study included patients admitted to the internal medicine ward. Consent for PMCT and autopsy was requested from the next of kin. Decedents were included when consent for at least PMCT was obtained. Consent for autopsy was not obtained for all decedents. All findings reported by PMCT were coded with an International Classification of Diseases (ICD) code. Unexpected findings were identified and subsequently categorized for their clinical relevance by the Goldman classification. Goldman class I and III were considered clinically relevant. Additionally, correlation with autopsy results and ante-mortem imaging was performed. Results: In total, 120 decedents were included and evaluated for unexpected findings on PMCT. Of them, 57 decedents also underwent an autopsy. A total of 1020 findings were identified; 111 correlated with the cause of death (10.9%), 508 were previously reported (49.8%), 99 were interpreted as post-mortem changes (9.7%), and 302 were classified as unexpected findings (29.6%). After correlation with autopsy (in 57 decedents), 24 clinically relevant unexpected findings remained. These findings were reported in 18 of 57 decedents (32%). Interestingly, 25% of all unexpected findings were not reported by autopsy. Conclusion: Many unexpected findings are reported by PMCT in hospitalized patients, a substantial portion of which is clinically relevant. Additionally, PMCT is able to identify pathology and injuries not reported by conventional autopsy. A combination of PMCT and autopsy can thus be considered a more comprehensive and complete post-mortem examination.

Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses

BackgroundNoninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography in a large cohort as part of routine clinical service has yet been unreported, and realistic “autopsy prevention rates” are unknown.ObjectiveThis study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary).Study DesignA prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016–2019). Imaging was reported by 2 pediatric radiologists before autopsy, with “decision to proceed” based on the specialist perinatal pathologists’ judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard.ResultsA total of 268 fetuses were included (2–350 grams body weight; 11–24 weeks’ gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound.ConclusionFetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected.

Can low autopsy rates be increased? Yes, we can! Should postmortem examinations in oncology be performed? Yes, we should! A postmortem analysis of oncological cases

Ever declining autopsy rates have been a concern of pathologists as well as clinicians for decades. Notably, in the field of oncology, data on autopsies and discrepancies between clinical and autoptic diagnoses are particularly scarce. In this retrospective study, we show the effect of a simple catalog of measures consisting of a different approach to obtain consent for autopsy, structured conferencing, and systematic teaching of residents, as well as a close collaboration between clinicians and pathologists on the numbers of autopsies, especially of oncological patients. Additionally, postmortem examination protocols from the years 2015 until 2019 were analyzed, regarding rates of discrepancies between clinical and autoptic causes of death in this category of patients. Autopsy numbers could be significantly increased from a minimum in 2014 (60 autopsies) to a maximum in 2018 (142 autopsies) (p < 0.0001). In the 67 autopsies of oncological cases, a high rate of 51% of major discrepancy between clinical and autoptic causes of death could be detected. In contrast to the general reported decline of autopsy rates, we present rising autopsy numbers over the past 5 years with an increasing number of oncological cases who underwent a postmortem examination. The high percentage of major discrepancies between clinical and autopsy diagnosis is in contrast to an expected decrease of major discrepancies in times of precise diagnostic methods and underlines the importance of autopsies to ensure high quality in diagnostics and therapy not only in the field of oncology.

Simultaneous primary hepatocellular carcinoma and neuroendocrine carcinoma

An 80-year-old woman with diabetes and nonalcoholic steatohepatitis -related cirrhosis was admitted for anorexia and epigastralgia. Although AFP, CA125, interleukin-2 receptor, and ferritin were elevated, PIVKA-II, CEA, CA19-9 were normal. CT revealed multiple tumors in the liver (S8), continuous one in the liver (S1) and pancreas, and lymphnodes (Fig. 1), which were absent one year before. She did not want further examination and died on the 17th day. Although her family did not give consent for autopsy, they agreed for needle necropsy of S8, hepato-pancreatic, and axillary tumors. The S8 tumor was diagnosed as hepatocellular carcinoma (HCC). The others showed undifferentiated tumor cells. Immunohistochemical examination showed these cells were positive for synaptophysin and CD56, but negative for low-molecular-weight keratin, high-molecular-weight keratin, CD45 and p63. Ki67 index was >80%. Thus, small cell neuroendocrine carcinoma (NEC) was diagnosed.

Resurrecting the Hospital Autopsy: Impact of an Office of Decedent Affairs on Consent Rates, Providers, and Next-of-Kin.

Autopsy rates have decreased dramatically despite providing important clinical information to medical practices and social benefits to decedents' families. To assess the impact of an institutional Office of Decedent Affairs (ODA), a direct communication link between pathology and decedents' families, on hospital autopsy consent rates, autopsy-related communication, practitioner views, and next-of-kin experiences. A before and after study involving all hospital decedents whose deaths did not fall within the jurisdiction of the medical examiner's office from 2013 to 2018. A pathology-run ODA launched in May 2016 to guide next-of-kin through the hospital death process (including autopsy-related decisions) and serve as the next-of-kin's contact for any subsequent autopsy-related communication. Critical care and hematology/oncology practitioners were assessed for their autopsy-related views and decedents' next-of-kin were assessed for their autopsy-related experiences. Autopsy consent rates for non-medical examiner hospital deaths, autopsy-related communication rates, practitioner views on the role and value of autopsy, and next-of-kin autopsy experiences and decisions factors were compared prior to and after ODA launch. Autopsy consent rates significantly increased from 13.2% to 17.3% (480 of 3647 deaths versus 544 of 3148 deaths; P < .001). There were significant increases in the rate of autopsy-related discussions and bereavement counseling provided to decedents' families. Practitioner views on the positive role of autopsy for any hospital death and those with advanced stage cancer also significantly increased. Next-of-kin indicated more consistent autopsy-related discussions with the potential benefits of autopsy discussed becoming key decision factors. An ODA improves hospital autopsy consent rates, autopsy-related communication, providers' autopsy-related views, and next-of-kins autopsy experiences.

Post mortem coronary angiography in a preemie heart \u2013 a case report

BackgroundPostmortem coronary angiography has been used in forensic medicine for several decades but its use has never been documented in neonatal hearts. The objective of this case is to report the use of postmortem coronary angiography as a diagnostic modality for neonates suspected to have complex congenital heart anomalies.Case presentationA 36-week-old female infant required extracorporeal membranous oxygenation for persistent hypotension on day 1 of life. A congenital echocardiogram (ECHO) on day 3 of life revealed multiple anomalous vascular structures within the interventricular septum. The infant passed away on day 4 of life after the parents elected to withdraw support. A consent for autopsy was taken from the parents and a postmortem coronary angiography was performed. The coronary vessels were injected with Iodixanol contrast via a 24 G angiocath under fluoroscopy. The anomalous septal vessels were identified as dilated coronary artery and vein. No other anomalies were identified.ConclusionPostmortem coronary angiography complements other imaging procedures in understanding the nature of some complex congenital heart defects and in determining the cause of death in such neonates.