New method of abdominal wall incision in autopsy]

The incision of the anterior abdominal wall proposed by the author is begun (after dissection of thoracic tissues on the median line) from processus xyphoideus sterni and led toward left regio iliacae (on the straight line or first on the left regio hypogastricae to its middle, then on liniae pararectalis) approximately till the middle of ligamentum Pouparti. Then from the lower end of this incision a transversal incision of superpubica is made at an angle, about 4--6 cm above simphysis ossium pubis, in adults 15--20 cm long. This incision provides a wide access to the organs of the small pelvis, demonstration of their changes on the spot, goes aside from median wounds or scars, and permits to penetrate from the transversal incision along the subcutaneous cellular tissue to the organs and tissues of regio subpubica.     

Demonstration of the argyrophil cells of the major glands in autopsy material]

A possibility of identifying endocrine argyrophil cells of the fundic glands of man by the method of impregnation with argentum after Grimelius in sectional material was studied. The cells detected by this method were found to be enterochromaffin-like (ECL) cells. Enterochromaffin (EC) cells in the autopsy material were not retained. Morphotopographic characteristics of ECL-cells in sectional material and bioptic specimens of the gastric mucosa were identical. One of the manifestations of post-mortem changes was adhesion of specific argyrophil granules contained in ECL-cells.     

Pneumocystis carnii pneumonia in AIDS--an autopsy report

Pneumocystis carinii pneumonia (PCP), the most common presenting manifestation in patients with AIDS from western countries, holds the distinction for being the first opportunistic infection that was associated with AIDS. There is marked paucity of clinically diagnosed and pathologically confirmed cases of PCP in India. This case represents the first complete autopsy report of pneumocystis carinii pneumonia inpatient with AIDS from our country. A high index of clinical suspicion and microscopic confirmation is needed to avert mortality due to PCP in patients with AIDS.     

Pseudomonas pneumonia in infants: an autopsy study

Pseudomonas pneumonia is an uncommon but serious infection in infants, occurring mainly in infants of low birth weight. In this retrospective clinicopathologic correlation study, we reviewed the clinical records and analyzed postmortem lung pathology in 8 infants with pneumonia due to P. aeruginosa. From the histopathology, 2 different pneumonic patterns emerged: a distinctive paucicellular coagulative confluent bronchopneumonia with perivascular bacillary infiltration (7 cases) and a more usual cellular pneumonia without evidence of perivascular organisms (1 case). Clinically, infants with the first type could be considered immunocompromised and had a precipitous course characterized by signs of sepsis, whereas the infant with the second type (who likely had a more normal immune system) had a relatively protracted course with respiratory failure. We conclude that (1) the pattern of pneumonic inflammation correlates with the immune state of infants, similar to what has been reported in adults; (2) among immunocompromised infants, histopathologic signs of bacteremia are prevalent; and (3) the clinical signs do not correlate with the severity of the pathology at autopsy and may reflect sepsis rather than pneumonia. We speculate that the histopathology in this population reflects the virulence of the organism, as well as the immune status of the host.     

Study of luminol-dependent chemiluminescence of peripheral blood in acute pneumonia]

Active oxygen forms (AOF) were measured in whole peripheral blood of 40 acute pneumonia patients using luminol-dependent spontaneous chemiluminescence (LDSC) and luminol-dependent zymosan-stimulated chemiluminescence (LDZSC) in the time course of the disease. Within week 1 of the disease both LDSC and LDZSC were increased in the majority of patients whereas low levels of AOF production served a predictor of poor prognosis in relation to acute pneumonia complications. If high intensity of LDSC and LDZSC persisted for 2 weeks pneumonia was likely to resolve completely though complications were possible. Protracted disease was associated with 3-week high AOF production. The data give evidence for possible application of LDSC and LDZSC of whole peripheral blood to predict complications and incomplete resolution of acute pneumonia.     

The frequency of hepatocellular carcinoma in autopsy material

The frequency of liver cell carcinomas (n = 249) in autopsies of adults (n = 36,074) from 1960 to 1981 was 0.69%; in males (n = 19,124) 1% (n = 192) and in females (n = 17,950) 0.34% (n = 57). The development of liver cell carcinoma was associated with cirrhosis of the liver in 87% of the cases (89% in males and 70% in females). The relative frequency of liver cell carcinoma in autopsies is increasing: 1960 to 1966 0.5%, 1967 to 1973 0.89%, 1974 to 1981 1.4%. This increase is mainly the result of the development of carcinoma after cirrhosis in males: 1960 to 1966 0.49%, 1967 to 1973 0.86% and 1974 to 1981 1.2%. Cirrhosis of the liver from 1974 to 1981 showed a continuous increase in the relative frequency and an age-shift towards younger age groups in males. Throughout the study period a history of alcohol abuse was frequently given in the patients history.     

Incidence of oesophageal necrosis in an autopsy material

The incidence of oesophageal necrosis was studied in 310 consecutive autopsies of patients more than 2 years old. The oesophagus and upper part of the stomach were excised and formalin-fixed in all cases suspicious of necrosis. Suspicious areas were taken out for microscopy. The necroses presented as dark coloured or black, punctate, striped or confluent areas, most frequently located in the lower third of the organ and usually stopping abruptly at the cardia. They were distinguished from autolytic changes by the presence of a vital reaction (i.e. fibrin exudation and presence of neutrophils). Necroses were observed in 32 of the 310 patients. In nine patients the necrosis extended into or through the muscularis propria. In 13 patients there was only mucosal necrosis. In the remaining cases the necroses extended into the submucosa. In one patient the necrosis caused fatal bleeding. We believe that oesophageal necrosis is a change which is often overlooked - whether presenting at endoscopy or at autopsy - and that the condition should be taken seriously as a cause of possible bleeding, perforation or septicemia. The cause is not firmly established, but the present as well as earlier works point to acid reflux combined with hypoperfusion as important pathogenetic factors.     

Study of systemic fungal infections in autopsy material

A retrospective study of 2526 autopsy cases was done in order to find out the pattern of systemic fungal infections. The autopsy records were reviewed for case histories, gross and histological findings. The histological sections from cases showing evidence of fungalo infections were reviewed. The fungal infections were found in 28 cases. Of these 11 (93.29 percent) were aspergillosis, 8 (28.27 percent) were mucormyosis, 6 (21.43 percent) were monilial infections and 3 (10.71 percent) were monilial infections and 3 (10.71 percent) were cryptococcosis. The incidence of systemic fungal infection was 1.11 percent. The most common type of fungal infection was aspergillosis. The maximum number of fungal infection was seen in the respiratory system. The fungal infections presented as opportunistic infections in all but one case. The metabolic disturbance was the most frequent predisposing condition for systemic fungal infections.     

Pulmonary bone marrow embolism in nonselected autopsy material

We analyzed the incidence of bone marrow emboli of the pulmonary arteries in nonselected autopsy material involving 620 cases. We evaluated the incidence of these emboli, age, sex, underlying disease and microscopic picture. It was found that bone marrow emboli of the pulmonary arteries occurred in 7% of cases, most frequently in patients aged from 50 to 69 years and they were located in the medium and small-lumen arteries. It was found that bone marrow emboli of the pulmonary arteries may complicate posttraumatic bone fractures, costal and sternal fractures in the course of reanimation as well as malignant neoplasms and shock.