Northern and Southern blot analysis of human RNA and DNA in autopsy material.

Fresh biopsy material for molecular biological investigations is not obtainable from all relevant normal human tissues. We studied the feasibility of using RNA and DNA from autopsies for Northern and Southern blot analysis. Tissue samples from seven organs were obtained from 10 autopsies performed 21-118 h postmortem. Extracted RNA and DNA were examined by Northern and Southern blot analysis using oligo-labelled human DNA probes recognizing gene transcripts of 2-5 kb. The results indicated that, in general, Northern blot analysis was feasible with the applied probes when the tissue was obtained less than two days postmortem. Histological examination showing slight or no autolysis and the presence of ribosomal bands after gel electrophoresis were both indicative parameters of RNA preservation. DNA was appropriate for Southern blotting when the tissue was obtained less than three to five days postmortem, depending on the organ from which the DNA was extracted.

Mortality statistics and autopsy: reliability of estimation of the mode of death in Copenhagen and a rural district of Sealand, Denmark.

During a one-year-period 1243 medicolegal deaths in the City of Copenhagen were autopsied after the mode of death was provisionally determined by an external medicolegal examination. In 35% of the cases an atuopsy was requested by the police. Without autopsy the mode of death would have been defined erroneously in 10.4% of all cases. This was particularly because of the difficulties in distinguishing between natural and non-natural death. In a rural district of Sealand in the autopsy rate in the same period was 14%. The rate among presumed natural deaths and accidents was particularly low (7% and 26%, respectively) against 23% and 77% in Copenhagen. This means a greater risk for errors in the estimated mode of death compared to Copenhage. This can also mean unequal rights by law. It is stressed that the police, in some rural areas, should be more liberal in requesting autopsies and at least increase them to the Copenhagen level of about 30%. The external medicolegal examination alone offers too little reliability, and it is stressed that such differences from one part of the country to another should not exist in a small well-organised country such as Denmark.

The importance of medico-legal autopsies. An analysis of the complex problems regarding damages.

One hundred forty-four medico-legal autopsies were performed at the University Institute of Forensic Medicine in Copenhagen during the period 1973-77, all requested by the National Office of Social Security in order to estimate whether the cause of death could be related to the work of the deceased. The total number of medico-legal autopsies in the same period was 4050. The material included only four women. One hundred seventeen men died during work, 26 cases were accepted. Clear cases of accidents were always accepted and damages were paid. In cases where the deceased died on his way to or from work damages were rejected. Nineteen men (13%) had died after returning to their homes. Two cases among these were accepted (fall from scaffolding during working hours, arsenic poisoning where death occurred later in hospital). The mean age of the group was about 50 years, which is less than in an average medico-legal population. In all cases but two the autopsy revealed the cause of death, i.e. that unknown causes of death totalled 1.4%. The manner of death was elucidated in all cases. The most frequent cause of death in men turned out to be coronary sclerosis and coronary thrombosis. All such cases were rejected as being due to working conditions, because in no case was extraordinary working stress found to be evident. The two cases of death which occurred at home showed the importance of being aware of injuries due to working conditions, even if death could not be directly related to an industrial accident.

Uncertainty of determining mode and cause of death without autopsy: an autopsy study of medically unattended non-medicolegal deaths.

Eighty-seven cases of medically unattended deaths were autopsied and investigated for alcohol and barbiturate after the general practitioner had certified the death. A detailed survey was made by comparing the mode and cause of death before and after autopsy. After autopsy and chemical analysis, two suicides, one accidental death and two unknown modes of death were found (5%). The high proportion of unknown mode of death was due to the fact that police investigations were not made. The cause of death differed in 30%. It was mostly due to overestimation of ischaemic heart disease, especially acute myocardial infarction, cerebral haemorrhage and because the unknown cause of death could be placed in a definite group after autopsy. Estimated acute myocardial infarciton could only be confirmed in 50% of the cases. Neoplastic disorders as the cause of death was seldom found to be erroneous, but malignancy was undiagnosed in 4% of all cases. It is concluded that doctors should not use acute myocardial infarction as a cause of death unless there is reasonable clinical evidence for the diagnosis, that obscure cases of death should be left to medicolegal investigation, and that the reliability of mortality statistics still has to be improved. The autopsy is still valuable to ensure this extra security.

The significance of medicolegal autopsy in determining mode and cause of death.

A comparative examination has been made to evaluate decisions as to causes and modes of death among 436 consecutive medicolegal deaths before and after coming to autopsy. All available information was used. including police reports, in evaluating mode and cause of death prior to the autopsy. Among the women, the mode of death evaluation differed in 23.4% of the cases and the cause of death evaluation differed in 77.5% of the cases. Among the men, the mode of death evaluation differed in 23.4% of the cases and the cause of death evaluation differed in 46.9% of the cases. These figures were achieved, however, on the basis of the fact that in most cases the mode of death and cause of death were reported as unknown. After autopsy, the cause of death remained unknown in 3.3% of the females over the age of 2 years and in 4.2% of the male over the age of 2 years. No characteristic relationship was established between the differences found and the age groups. The investigation shows the importance of the medicolegal autopsy for correctly recording cases where the death is obscure.

Uncertainty of determining mode of death in medicolegal material without autopsy--a systematic autopsy study.

Systematic autopsy was performed in 807 medicolegal deaths where the police had not requested autopsy. In all cases both the cause of death and the mode of death had been reported at the medicolegal external examination. The autopsy revealed differences in the mode of death in about 4% of all cases. This was due in particular to the problems associated with distinguishing presumed natural deaths from accidents and suicide. The cases of "concealed" suicide were found in particular among the higher age groups. However, no characteristic relationship was found between the proportion of differing modes of death and the age groups. All cases of homicide were recognized at the medicolegal external examination. Malignant disease that had not been diagnosed previously was found in about 4% of the cases, the reason being the large proportion of elderly subjects in the material. Syphilitic aortitis that had not been previously diagnosed was demonstrated in about 1% of all cases, and pulmonary tuberculosis that had not been previously diagnosed was demonstrated in 0.7% of the cases. The conclusion is that the results provide no support for replacing the medicolegal autopsy by medicolegal external examination alone, but rather suggest that the proportion of medicolegal autopsies should be increased.

The value of the hospital autopsy. A study of causes and modes of death estimated before and after autopsy.

Among 312 consecutive deaths in a Danish Central Hospital autopsy was performed in the pathology department on 266 cases, i.e. 85%. Retrospectively, the underlying causes of death were estimated from the clinical information alone by an experienced clinician and subsequently compared with the autopsy report. The definite cause of death was determined jointly by the clinician and the pathologist. The clinician's diagnosis was thereby confirmed as incorrect in 18% of the cases if small differences in site and type of malignant tumours were not considered. This is less than in many other investigations, but it is stressed that this could partly be because formal errors in completing the death certificate were avoided. The main causes of death were ischaemic heart disease and neoplasia. Clinical diagnosis of malignant diseases was never found to be erroneous. There was a slight tendency to clinically overestimate ischaemic heart disease, but in general the different errors outweighed each other, so that the total number of different causes of death before and after autopsy was nearly the same. The original death certificate was investigated in 12 accidental cases. Hereby it was found that the mode of death was originally stated erroneously as natural in 7 cases, i.e. 4.5%. It is concluded that hospital autopsy is still needed for the control and correction of causes of death, and it is stressed that clinicians as well as pathologists should be more aware of cases with a trauma in the history to avoid errors in the mode of death. Such errors can imply legal as well as insurance problems.

[Insect allergy and sudden unexpected death]. / Insektallergi og pludselig, uventet død.

A case of sudden unexpected death after an insect sting in a middle aged man known to be allergic to insect stings is presented. In connection with an allergic shock, many years before death occurred, he had been offered allergological investigation. If the directives in the consensus report on insect sting allergy, recently published by the Danish Association for Allergology had been followed, similar deaths and expensive visits to casualty departments could probably be reduced.

[Oral contraception and thromboembolic deaths. Forensic autopsy material]. / Oral antikonception og tromboemboliske dødsfald. Et retsmedicinsk obduktionsmateriale.

PIP: The number of female deaths in 1950-1957 due to cardiovascular disease is compared with the number from 1962 to 1969 to determine if use of oral contraceptives causes increased risk of thromboembolic disease. 30 women died in 1950-1957 and 51 died in 1962-1969, which showed a statistically significant increase. Of the 10 women who died from pulmonary embolism in 1962-1969, 4 had used oral contraceptives, and of the 19 women who died from coronary thrombosis in the same period, 2 had used oral contraceptives. 2 women who were using oral contraceptives died soon after the implantation of an IUD. The data are not large enough to indicate a causal relationship between the use of oral contraceptives and death from cardiovascular disease.^ieng

[Phlegmonous gastritis in pregnancy--a case with fatal course]. / Flegmonøs gastritis i graviditeten--et dødeligt forløbende tilfaelde.

A case of maternal death and still birth in the 35th week of pregnancy is described where the cause of death was the very rarely diagnosed phlegmonous gastritis. The phlegmonous gastritis is characterised by dangerous, fulminating pyogenic bacterial infection of the gastric wall with alpha-haemolytical streptococci. The entity seems to have been well-known earlier, but has only been reported sparsely in contemporary medical literature. It cannot be ruled out that the disease may have been misdiagnosed on several occasions in recent decades because of symptomatic treatment. In presenting the case, the authors seek to attract attention to this disease--that according to the contemporary medical literature seems mostly to be induced by modern treatment with antacids and after gastroscopy--because it can be effectively treated with modern antibiotics, possibly in combination with gastrectomy.