Postmortem Needle Research Articles

Large Scale Study of H1N1 Influenza Cases: A Novel Approach Using Post-Mortem Needle Biopsy

Considering few H1N1 pathology reports based on autopsies & biopsy studies only in seasonal influenza; our series of 70 postmortem needle biopsies in H1N1 Influenza is worth documenting. Decedents with severe respiratory illness & strong clinical suspicion of H1N1 influenza in 2009 pandemic were studied. Nasopharyngeal swabs for RT-PCR & post mortem biopsies were taken. 51.4% were H1N1 positive & 48.6% were negative on RT-PCR. Most of H1N1+ve cases showed interstitial pneumonia & intra-alveolar hemorrhages & DAD in lung & fatty change in liver. Similar histopathology of majority of H1N1 RT-PCR negative & positive cases prompts need for confirmation of negative cases by ancillary methods. Rapid & safe diagnosis of H1N1 Influenza can be obtained by biopsy if supplemented by IHC to get accurate estimate of disease prevalence & mortality. Sufficient biopsy sampling can provide insight into H1N1influenza pathology & eliminate need for autopsies considering high infectivity of disease.

Pathologic study of pandemic influenza A (H1N1) 2009 cases from India

The pandemic influenza A (H1N1) 2009 originated in Mexico and rapidly spread to the United States and many other countries. India reported the first pandemic influenza case in May 2009. Autopsy studies describing the pathology of pandemic influenza infection in humans have appeared in the literature and most of these were from Western countries. We present the clinicopathologic features in 46 fatal cases with confirmed pandemic influenza A (H1N1) 2009 virus infection during August 2009 to October 2010. Postmortem needle biopsy tissues were examined for histopathological changes and distribution of virus antigen by immunohistochemistry. The results are comparable with previous autopsy studies. Diffuse alveolar damage was the consistent finding in the lung tissues. However, underlying medical conditions were not noted in the cases from present study. Consistent presence of viral antigen was noted in the bronchiolar epithelium without any reference to the duration of illness. This study also emphasizes the use of the postmortem needle biopsy technique whenever an autopsy is not possible.

Family and community concerns about post-mortem needle biopsies in a Muslim society

BackgroundPost-mortem needle biopsies have been used in resource-poor settings to determine cause of death and there is interest in using them in Bangladesh. However, we did not know how families and communities would perceive this procedure or how they would decide whether or not to consent to a post-mortem needle biopsy. The goal of this study was to better understand family and community concerns and decision-making about post-mortem needle biopsies in this low-income, predominantly Muslim country in order to design an informed consent process.MethodsWe conducted 16 group discussions with family members of persons who died during an outbreak of Nipah virus illness during 2004-2008 and 11 key informant interviews with their community and religious leaders. Qualitative researchers first described the post-mortem needle biopsy procedure and asked participants whether they would have agreed to this procedure during the outbreak. Researchers probed participants about the circumstances under which the procedure would be acceptable, if any, their concerns about the procedure, and how they would decide whether or not to consent to the procedure.ResultsOverall, most participants agreed that post-mortem needle biopsies would be acceptable in some situations, particularly if they benefitted society. This procedure was deemed more acceptable than full autopsy because it would not require major delays in burial or remove organs, and did not require cutting or stitching of the body. It could be performed before the ritual bathing of the body in either the community or hospital setting. However, before consent would be granted for such a procedure, the research team must gain the trust of the family and community which could be difficult. Although consent may only be provided by the guardians of the body, decisions about consent for the procedure would involve extended family and community and religious leaders.ConclusionsThe possible acceptability of this procedure during outbreaks represents an important opportunity to better characterize cause of death in Bangladesh which could lead to improved public health interventions to prevent these deaths. Obstacles for research teams will include engaging all major stakeholders in decision-making and quickly building a trusting relationship with the family and community, which will be difficult given the short window of time prior to the ritual bathing of the body.

Diagnosis of fatal pulmonary fat embolism with minimally invasive virtual autopsy and post-mortem biopsy

We report a case of a 78-year-old female with a proximal femur fracture caused by an accidental fall who died suddenly 1 h after orthopaedic prosthesis insertion. Post-mortem computed tomography (CT) scan and histological examination of samples obtained with post-mortem percutaneous needle biopsies of both lungs were performed. Analysis of the medical history and the clinical scenario immediately before death, imaging data, and biopsy histology established the cause of death without proceeding to traditional autopsy. It was determined to be acute right ventricular failure caused by massive pulmonary fat embolism. Although further research in post-mortem imaging and post-mortem tissue sampling by needle biopsies is necessary, we conclude that the use of CT techniques and percutaneous biopsy, as additional tools, can offer a viable alternative to traditional autopsy in selected cases and may increase the number of minimally invasive forensic examinations performed in the future.

A Case of Methimazole-Induced Acute Hepatic Failure in A Patient with Chronic Hepatitis B Carrier

We report a case of methimazole-induced acute hepatic failure, which occurred 17 weeks after initiation of the drug in a 43-year-old man with hyperthyroidism and hepatitis B surface antigenemia. Postmortem needle autopsy of the liver revealed an established micronodular cirrhosis secondary to hepatitis B with moderate septal/portal inflammation, marked cholestasis and scattered acidophilic bodies. The serum hepatitis B surface antigen (HBsAg) was positive, but reactivation of hepatitis B was unlikely in view of the absence of a serum hepatitis B e antigen (HBeAg) and hepatitis B virus deoxyribonucleic acid (HBV-DNA) and negative stain for HBsAg and hepatitis B core antigen (HBcAg) in the liver tissue.

Isolation of Japanese encephalitis virus from clinical specimens using a continuous mosquito cell line.

During the 1983 Japanese encephalitis (JE) epidemic in northern Thailand, we systematically attempted to isolate JE virus (JEV) from clinical specimens collected from 49 consecutive JE patients at 1 provincial hospital. Fresh acute plasma and cerebrospinal fluid (CSF) samples and postmortem brain samples were immediately inoculated onto cultured monolayers of Aedes pseudoscutellaris (LSTM-AP-61) cells which had been shipped to the epidemic site. None of 49 plasma samples yielded virus. None of 30 fresh CSF samples from nonfatal cases yielded virus, but 5 of 15 (33%) CSF samples from fatal cases did. Inoculation of fresh brain specimens obtained at autopsy yielded virus in every case attempted (7 of 7), whereas postmortem needle biopsy specimens of brain yielded virus in only 1 of 4 cases. Isolates were most frequently successful using thalamic tissue (6 of 7 cases), but isolates were also commonly obtained from frontal cortex (4/7), occipital cortex (4/7), cerebellum (4/7), medulla (4/7) and pons (2/7).

Leukaemic infiltration of the prostate

Leukaemic infiltration of the prostate is not a common occurrence. Two cases, both from country hospitals in Victoria (Bendigo and Hamilton) are presented in this communique. The first one, 75-yr-old, initially presented in August 1977 with splenomegaly and generalized lymphadenopathy. Diagnosis of chronic lymphatic leukaemia was confirmed from marrow examination. He soon developed urinary symptoms of prostatism, which did not improve on chemotherapy for leukaemia. Transurethral prostatic resection was undertaken when histological examination showed neoplastic infiltration of the prostatic stroma by well differentiated lymphocytes. The second patient, 67 yr old, in very good health except for intermittent urinary retention symptoms was admitted in January 1978 in Bendigo for prostatectomy. Chronic lymphatic leukaemia was discovered on routine blood examination before the operation and subsequently confirmed by marrow studies. Chemotherapy was initiated and a few weeks later, transurethral prostatectomy was carried out. Histology revealed massive neoplastic lymphocytic infiltration of the stroma. Review of the literature on the subject revealed sporadic reporting of the individual cases. Precise incidence is unknown. Cases have been diagnosed from postmortem material, surgical specimens and needle biopsies. Attention is drawn to the lack of careful and critical examination of the prostate during autopsy of leukaemic patients. Needle biopsy of the prostate may yield a false negative result in the event of focal leukaemic infiltration of the prostatic stroma. A contributory role of the infiltration towards obstructive urinary symptoms is debatable, although, in one case of acute myeloid leukaemia, local radiotherapy completely relieved the symptoms. Urinary retention has been reported more often in association with granulocytic leukaemia than lymphatic leukaemia. Prostatectomy in chronic lymphatic leukaemic patients with prostate involvement seems to be without any post-operative complication, treatment of leukaemia itself being indicated only on medical grounds.

Intramitochondrial crystalloid inclusions in neuronal processes of human cerebral cortex.

Orbital cortex specimens obtained as postmortem brain needle samples from 4 of 7 elderly subjects contained inclusion-carrying mitochondria in a small percentage of neuronal processes. Banded, lattice-like and hexagonal patterns were all seen in the inclusions. These patterns are thought to result from different planes of section through ordered aggregates of tubules. The crystalloid inclusions in mitochondria are tentatively regarded as a morphologic variant within the normal range, possibly brought about by some metabolic changes intervening, for instance, just before death.

Subacute hepatitis. its clinicopathological observation

40 cases with fulminant hepatitis including 26 of infectious, 12 of serum, and 2 of toxic hepatitis were studied. The cases were selected from those with hepatic disorders observed during the period from June, 1957 to September, 1968 on the bases of clinical findings together with liver function tests and histological evidence for fulminant hepatitis. Histological criterion was massive or submassive necrosis of hepatic parenchyme. 17 of 24 acutely as well as subacutely fatal cases were autopsied and postmortem needle aspiration of liver performed in 5 cases. Single biopsy was carried out in one fatal hepatitis and 62 in 23 cases with subacute hepatitis.

Blunt-End Needle Biopsy of Pleura and Rib

The frequent involvement of parietal pleura in thoracic diseases has been confirmed by numerous studies of pleural tissue obtained at postmortem examination, surgery, thoracoscopy, and needle biopsy.1Efforts to secure pleural tissue by needle aspiration, particularly in patients with an effusion, have been reported many times but with highly variable conclusions regarding the diagnostic value of the procedure. In this country the Vim-Silverman or endbiting type of biopsy instrument generally has been used.2With this needle, an insufficient was obtained in from 10% to 40% of the patients studied.1,3-7Misra and Sharma were able to obtain pleural tissue with every attempt, but in an unspecified number repeat biopsy was necessary to obtain a specimen adequate for study.8At our institution efforts to secure pleural specimens with the Vim-Silverman needle failed so frequently that the procedure was abandoned. Dr. Constantin Cope devised a new instrument*to