Needle necropsy in AIDS

The value of autopsy in understanding the natural course of any disease is beyond any argument. The reluctance of pathologists to perform autopsy in HIV infected cadavers is justified due to the risks involved to the prosector and the morgue attendants. A relative low risk needle necropsy protocol is proposed using fine needle aspiration cytology, tru-cut biopsies and microbiological examination. Diagnosis could be offered in all the forty-four needle necropsies performed. Disseminated tuberculosis in 18/44 (40.9%) cases, disseminated cryptococcosis in 12/44 (27.2%) cases, poly-microbial infections in 27.2% cases and non-Hodgkin's lymphoma in 9% cases were detected in the study. Infectious agents like Histoplasma capsulatum, Isospora belli, tachyzoites of Toxoplasma gondii, Candida sp and Cryptococcus sp could be demonstrated in the samples obtained in the study. Lack of material for study of gross pathology, inaccessibility of deep-seated lesions and risk of needle stick injury to the prosector though low are the limitations of this procedure.     

Notes on necropsy.

From the above it can be seen that autopsy is not a grotesque, macabre procedure performed for peculiar and disreputable reasons in a remote corner of the hospital. On the contrary, it is a scientific study designed to forward our knowledge of health and disease by the three primary methods of service, teaching and research. The examination of a dead body is always an emotional procedure. The pathologist and those concerned with frequent performance of autopsies become accustomed to it. To witness an autopsy may cause considerable emotional reaction in inexperienced people. As part of the learning experience, it can be very useful and appropriate staff are welcome to attend by arrangement. As proper protection garments are required and the suitability of viewing certain autopsies may arise, a formal request to the responsible pathologist is necessary. Whatever one's religious beliefs, it may be helpful to think of the deceased person's body as something which he or she has used during life, but which is no longer in any real way the persons once life has departed. The decreased body must be treated with dignity and respect as representing the remains of what was a human being and because of the natural desire of the next of kin that the remains of their relative should so be treated; it is not the person who used the body during life.     

Interpreting bruises at necropsy

The accurate interpretation of bruising at necropsy is essential to understanding how a victim has been injured and assists the pathologist in a reliable reconstruction of the events leading to death. It is essential not only to assess the mechanism of production of a bruise, taking into account the type of impacting surface and the magnitude of force used, but also to estimate when the injury was caused. An account is given of the various methods used in the examination of bruises, particularly with respect to aging, as well as the factors that may affect their appearance. Differentiation from artefacts resulting from postmortem changes is also discussed in some detail.     

Health and safety at necropsy

The postmortem room is a source of potential hazards and risks, not only to the pathologist and anatomical pathology technician, but also to visitors to the mortuary and those handling the body after necropsy. Postmortem staff have a legal responsibility to make themselves aware of, and to minimise, these dangers. This review focuses specifically on those hazards and risks associated with the necropsy of infected patients, with foreign objects present in the body, and with bodies that have been contaminated by chemicals or radioactive sources.     

Cytodiagnosis and the necropsy.

AIMS--To assess the efficacy of cytodiagnosis in necropsy practice. METHODS--Fifty three focal lesions from 46 necropsies were assessed by direct smears taken from the lesions. The smears were air-dried and stained by a modified Giemsa technique, with two cases having supplementary histochemistry. All of the slides were assessed independently before review of the necropsy histology. RESULTS--Of the 35 malignant neoplasms, 34 were correctly identified as malignant and 14 of these were characterised precisely. Three of the four benign neoplasms were recognised as neoplastic. One was characterised precisely. Three of the four infected cases revealed the relevant microorganisms. Seven of the other 10 focal non-neoplastic lesions were correctly diagnosed as non-neoplastic. Only two cases proved unsatisfactory for cytodiagnosis. CONCLUSIONS--Direct smear cytodiagnosis is quick, cheap and technically simple. Tissue autolysis may account for some difficulty in assessing particular tissues, but this should diminish with experience. Necropsy cytodiagnosis is applicable to all necropsies in all centres.     

Have declining clinical necropsy rates reduced the contribution of necropsy to medical research?

AIMS--To examine trends in necropsy based research output for a period of 27 years during which there has been a progressive decline in clinical necropsy rates. METHODS--The numbers of necropsy based research papers published between 1966 and 1993 were determined using the CD-Plus Medline computed literature database. RESULTS--The number of necropsy based research papers containing necropsy or a synonym in the title increased by 220% between 1966 and 1993. When papers including necropsy or a synonym in the abstract, but not in the title, were included, the proportion of all indexed papers increased from 0.35% in 1975, when abstracts were first included, to 0.53% in 1993. Analysis of the subject material indicated that necropsy based research has constantly reflected trends and advances in clinical medicine. Neuroscience related research represented the largest subject category which may reflect the difficulties in obtaining human tissue from sources other than necropsy. CONCLUSIONS--The modern necropsy continues to provide valuable information for all clinical and laboratory based disciplines. The decline in clinical necropsy rates would not yet appear to have undermined the contribution of the necropsy to research.     

Ultrasound in the perinatal necropsy.

Although plain and contrast radiology have become a well established part of the perinatal and fetal necropsy, the role of ultrasound has been less comprehensively explored. We have found a variety of ultrasonographic approaches to be of value in diagnosis, quality control, and teaching. Ultrasound is of particular help where consent for formal necropsy has been declined.     

Asbestos bodies in lungs at necropsy

This study was made in Glasgow, Scotland, near an industrial area where ship building is an important industry. Asbestos bodies were found in 23% of 100 consecutive hospital necropsies, bodies were present in 37% of the 62 males, none were found in 38 females. These findings are compared with results of other similar surveys. In 85.4% of cases showing asbestos bodies, hyaline pleural plaques were found. There was one case of asbestosis and three of bronchial carcinoma in the cases showing asbestos bodies.     

Identification of fungal diseases at necropsy

The purpose of the Death Verification Service is to elucidate the causes of deaths that occur without medical assistance and of ill-defined deaths. In recent decades, the epidemiological reality of fungal infections has changed due to the rise in opportunistic infections chiefly in immunocompromised patients.     

Value of perinatal necropsy examination.

In a retrospective study of 150 stillbirths and 150 neonatal deaths carried out between 1981 and 1985 the necropsy findings were compared with the clinical diagnoses, which had been obtained from the postmortem request form, and the case notes completed before the necropsy was performed. In all cases the necropsy comprised macroscopic findings and histological examination of all organs, with microbiology, radiology, and cytogenetics where appropriate. Clinically important differences between clinical and pathological diagnoses in 54 of 150 cases (36%) were noted in the cases of stillbirth. Of the neonatal deaths, examination showed clinically important information that had not been recognised during life in 66 cases (44%). Histological examination of tissues was essential for making or confirming the pathological diagnosis in 20% of all perinatal deaths.