Post-mortem imaging in adults

Post-mortem computed tomography (PMCT), offers a non-destructive approach to the investigation of fatal injuries and the diagnosis of deaths from natural causes. Strengths of PMCT include the demonstration of fractures, internal haemorrhage, vascular disease and tumours. Imaging can be combined with minimally invasive techniques in the investigation of deaths secondary to sepsis, metabolic causes and drug toxicity. Unlike traditional invasive autopsy, PMCT creates an observer-independent permanent record of the findings that is amenable to audit, and may be used for courtroom or other demonstration. In the United Kingdom, PMCT is increasingly used as a first line technique in coronial investigation. The cause of death can be ascertained without open autopsy in the majority of cases. The use of PMCT in the UK is driven by religious and cultural objections to invasive autopsy, a shortage of autopsy pathologists and concerns regarding the quality of autopsies. Despite the backing of the Royal Colleges and the Chief Coroner, a number of logistical and financial challenges must be overcome in developing a national service.     

Post-mortem toxicology of commonly-abused drugs

Post-mortem redistribution and other changes present major obstacles to the interpretation of drug concentrations in the dead. Nevertheless, reasonable assessments can still be made by the pathologist and toxicologist as to the contribution that commonly-abused drugs may have made to the death. The best assessments may be obtained by the implementation of the investigation along the following lines: (1) carefully select, store, preserve and utilize the post-mortem tissue samples intelligently for appropriate toxicological and histological analyses; (2) use as much information concerning the circumstances of the demise as possible to guide the procedures in step 1; (3) factor in prevalence of drug use and estimated fatality risks of such use within the particular group concerned to determine whether or not additional analytical work is required; (4) consider how these drugs behave in the body ante- and post-mortem, with and without disease states, together with any other factors such as tolerance; (5) consider the toxicological results in the context of macroscopic and histological autopsy findings.     

Post-mortem examination after cardiac surgery

Following a recent enquiry into surgery at a paediatric cardiac centre in England, there will be substantial changes in the way that the success and failure of surgical procedures will be monitored and investigated. Post-mortem examinations on patients dying after cardiac surgery are likely to be performed and reported in more detail. This review describes the protocol that we have developed and summarizes recent clinical and pathological studies that have increased our understanding of postoperative pathophysiology. Close attention should be paid to the history, particularly the operation note. Cardiac failure is the commonest cause of death. We believe this is a clinicopathological diagnosis and provide definitions of preoperative and perioperative cardiac failure. Haemorrhage, stroke, pulmonary emboli and infection are other important causes of death. Methods of dissection are suggested for bypass grafts and valve replacements. Two recent studies show that the post-mortem examination provides answers to most clinical questions and reveals an unexpected cause of death in 10–15% of patients. There are limitations however: an incomplete or indeterminate cause of death is found in 14–25% of patients, most commonly sudden clinically unexplained death or clinically unexplained cardiac failure soon after surgery.     

Post-mortem findings in Irish culled hounds

Little is known of the common diseases of hunting dogs or of the reasons why they are culled. To address these questions, necropsy examinations were conducted on 52 hounds aged 1.5-12 years (mean 6.5 ± 2.5 years) and culled from 10 Irish hunting kennels over a 3-year period. Progressive systemic disease was seen in six dogs only and encompassed individual cases of tuberculosis caused by Mycobacterium bovis, bronchioalveolar carcinoma with metastasis to regional lymph nodes, renal amyloidosis, suppurative pneumonia, extramedullary plasmacytoma in the atrial wall of the heart and foreign body-induced hepatitis with focal peritonitis. Single or multiple localized tumours were identified in five dogs and, apart from the aforementioned, included two cutaneous haemangiomas, a trichoepithelioma, a lipoma and a mammary ductal adenoma. Three dogs were culled for lameness; one of these dogs had torn musculature, another had cellulitis and the third had a healed fracture of the tibia and fibula. Chronic renal changes were present in 48% of the dogs and included focal proliferative, exudative or crescentic glomerulonephritis (33%) or low-grade interstitial inflammatory changes (50%). The most frequently diagnosed skin lesions reported in this study were mild healed decubitus ulcers (33%), scars (33%) and stereotypic dermatitis (13%). These findings indicate that hounds are likely to be culled for reasons other than the presence of disease in most cases. In addition, this survey highlights different disease patterns in hounds than are typically observed in pet dogs.     

Ultrastructural Appearances of Disseminated Superficial Actinic Porokeratosis

The ultrastructure of the cornoid lamella and adjacent epidermis was studied by transmission electron microscopy in seven patients with disseminated superficial actinic porokeratosis (DSAP). In the region of the cornoid lamella similar ultrastructural changes were seen in various degrees in all cases. The main changes were seen in various degrees in all cases. The main changes included reduplication of the basal lamina at the dermo-epidermal junction, vacuolar change in the keratinocytes with numerous autophagic vacuoles, glycogen accumulation, dyskeratotic cells, parakeratotic cells containing degraded organelles, and a reduced granular layer.     

Ultrastructural Appearances of Disseminated Superficial Actinic Porokeratosis

The ultrastructure of the cornoid lamella and adjacent epidermis was studied by transmission electron microscopy in seven patients with disseminated superficial actinic porokeratosis (DSAP). In the region of the cornoid lamella similar ultrastructural changes were seen in various degrees in all cases. The main changes were seen in various degrees in all cases. The main changes included reduplication of the basal lamina at the dermo-epidermal junction, vacuolar change in the keratinocytes with numerous autophagic vacuoles, glycogen accumulation, dyskeratotic cells, parakeratotic cells containing degraded organelles, and a reduced granular layer.     

Post-mortem stability of membrane-associated sialidase activity in brain

The post-mortem changes in membrane-associated sialidase (N-acetylneuraminosyl glycohydrolase, EC 3.2.1.18) were examined in rat brain obtained and stored in a manner which paralleled neuropathological handling of human brains. When whole brains were held at 4 degrees C in covered containers for varying periods of time (0.67 h), sialidase activity toward endogenous membrane substrate was elevated. This elevated activity was maximal at 8 h of storage and decreased thereafter. The apparent decrease in enzyme activation from 8 to 67 h of storage was not due to a reduction of activity, but was the result of depletion of endogenous membrane substrate, since activity toward exogenous ganglioside remained elevated. The changes were due to whole brain storage at 4 degrees C, and not a result of being stored at -80 degrees C. The post-mortem activation of sialidase was not due to the expression of a new form of the enzyme, since it displayed characteristics similar to those reported previously: (a) membrane gangliosides being the preferred native substrate, and (b) ganglioside GM1 and lactosylceramide being the major hydrolytic products. The results underscore the importance of post-mortem storage conditions when analyzing complex carbohydrates of brain.