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1.
Acta Obstet Gynecol Scand ; 100(2): 314-321, 2021 02.
Article in English | MEDLINE | ID: mdl-32959373

ABSTRACT

INTRODUCTION: Stillbirth remains an often unpredictable and devastating pregnancy outcome, and despite thorough investigation, the number of stillbirths attributable to unexplained causes remains high. Placental examination has become increasingly important where access to perinatal autopsy is limited. We aimed to examine the causes of stillbirth in normally formed infants over 30 years and whether a declining autopsy rate has affected our ability to determine a cause for stillbirths. MATERIAL AND METHODS: All cases of normally formed singleton infants weighing ≥500 g that died prior to the onset of labor from 1989 to 2018 were examined. Trends for specific causes and uptake of perinatal autopsy were analyzed individually. RESULTS: In all, 229 641 infants were delivered, with 840 stillbirths giving a rate of 3.66/1000. The rate of stillbirth declined from 4.84/1000 in 1989 to 2.51 in 2018 (P < .001). There was no difference in the rate of stillbirth between nulliparous and multiparous women (4.25 vs 3.66 per 1000, P = .026). Deaths from placental abruption fell (1.13/1000 in 1989 to 0 in 2018, P < .001) and the relative contribution of placental abruption to the incidence of stillbirth also fell, from 23.3% (7/30) in 1989 to 0.0% (0/19) in 2018 (P < .001). Stillbirth attributed to infection remained static (0.31/1000 in 1989 to 0.13 in 2018, P = .131), while a specific causal organism was found in 79.2% (42/53) of cases. Unexplained stillbirths decreased from 2.58/1000 (16/6200) in 1989 to 0.13 (1/7581) in 2018 (P < .001) despite a fall in the uptake of perinatal autopsy (96.7% [29/30] in 1989 to 36.8% (7/19) in 2018; P < .001). Placental disease emerged as a significant cause of stillbirth from 2004 onwards (89.5% [17/19] in 2018). CONCLUSIONS: The present analysis is one of the largest single-center studies on stillbirth published to date. Stillbirth rates have fallen across the study period across parity. A decrease in deaths secondary to placental abruption contributed largely to this. Infection-related deaths are static; however, in one-fifth of cases a causative organism was not found. Despite a decreasing autopsy rate, the number of unexplained stillbirths continues to fall as the importance of placental pathology is increasingly recognized.


Subject(s)
Stillbirth/epidemiology , Abruptio Placentae/epidemiology , Autopsy/trends , Cross-Sectional Studies , Female , Hemorrhage/epidemiology , Humans , Incidence , Infant, Low Birth Weight , Infant, Newborn , Ireland/epidemiology , Parity , Placenta Diseases/epidemiology , Pregnancy , Pregnancy Complications, Hematologic/epidemiology , Pregnancy Complications, Infectious/epidemiology , Retrospective Studies
2.
Am J Forensic Med Pathol ; 41(4): 242-248, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32732591

ABSTRACT

The historically constricted forensic pathology workforce pipeline is facing an existential crisis. Pathology residents are exposed to forensic pathology through the American Council of Graduate Medical Education autopsy requirement. In 1950, autopsies were conducted in one half of the patients dying in American hospitals and 90% in teaching hospitals, but they have dwindled to fewer than 5%. Elimination of funding for autopsies is a major contributor to the lack of support for autopsies in departments of pathology. Funding may require reclaiming the autopsy as the practice of medicine. Funding of autopsies would rekindle interest in hospital autopsies and strengthen the forensic pathology workforce pipeline.


Subject(s)
Autopsy/economics , Autopsy/trends , Health Workforce/trends , Fellowships and Scholarships/statistics & numerical data , Forensic Pathology/education , Forensic Pathology/trends , Humans , Internship and Residency/statistics & numerical data , Internship and Residency/trends , Medicare , Pathology, Clinical/education , Pathology, Clinical/trends , Reimbursement Mechanisms , Students, Medical/statistics & numerical data , United States
3.
Clin Infect Dis ; 69(Suppl 4): S257-S259, 2019 10 09.
Article in English | MEDLINE | ID: mdl-31598658

ABSTRACT

Current understanding of the causes of under-5 childhood deaths in low- and middle-income countries relies heavily on country-level vital registration data and verbal autopsies. Reliable data on specific causes of deaths are crucial to target interventions more effectively and achieve rapid reductions in under-5 mortality. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to systematically describe causes of child death and stillbirth in low- and middle-income countries using minimally invasive tissue sampling. The articles in this supplement introduce the set of foundational epidemiologic, demographic surveillance, social behavioral science, and laboratory methods. Undergirding the CHAMPS surveillance system designed to determine causes of child mortality.


Subject(s)
Cause of Death/trends , Child Health/trends , Child Mortality/trends , Autopsy/trends , Child , Humans , Population Surveillance/methods , Stillbirth/epidemiology
4.
Clin Infect Dis ; 69(Suppl 4): S262-S273, 2019 10 09.
Article in English | MEDLINE | ID: mdl-31598664

ABSTRACT

Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24-36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia.


Subject(s)
Cause of Death/trends , Child Health/trends , Child Mortality/trends , Africa South of the Sahara/epidemiology , Asia/epidemiology , Autopsy/trends , Child , Global Health/trends , Humans , Population Surveillance/methods , Stillbirth/epidemiology
5.
Am J Med Genet C Semin Med Genet ; 181(1): 36-42, 2019 03.
Article in English | MEDLINE | ID: mdl-30633443

ABSTRACT

At the Third Turner Resource Network Symposium, a working group presented the results of collaborative discussions about the importance of autopsy in Turner syndrome (TS). Considerable gaps in understanding the causes of death in TS can only be closed by more frequent death investigations and autopsies. The presentation included an overview of autopsy methods, strategies for utilizing autopsy, and biobanking to address research questions about TS, and the role of palliative care in the context of autopsy. This review highlights strategies to promote autopsy and tissue donation, culminating with an action plan to increase autopsy rates in the TS community.


Subject(s)
Autopsy/trends , Tissue and Organ Procurement/trends , Turner Syndrome/diagnosis , Autopsy/methods , Female , Humans
6.
Ultrasound Obstet Gynecol ; 54(6): 791-799, 2019 Dec.
Article in English | MEDLINE | ID: mdl-30644623

ABSTRACT

OBJECTIVE: To compare the diagnostic rate and accuracy of 3-Tesla (T) postmortem magnetic resonance imaging (PM-MRI) and postmortem ultrasound (PM-US) in an unselected fetal population. METHODS: We performed prospectively, in a blinded manner, 3-T PM-MRI and PM-US on 160 unselected fetuses at 13-41 weeks of gestation. All imaging was reported according to a prespecified template, for five anatomical regions: brain, thorax, heart, abdomen and spine. The rates of non-diagnostic results for PM-US and PM-MRI were compared and, for results that were diagnostic, we calculated sensitivity, specificity and concordance rates for each anatomical region, using conventional autopsy as the reference standard. RESULTS: 3-T PM-MRI performed significantly better than did PM-US overall and in particular for fetuses ≥ 20 weeks' gestation. Specifically, the non-diagnostic rates for PM-MRI vs PM-US were 4.4% vs 26.9% (7/160 vs 43/160; P < 0.001) for the brain, 5.2% vs 17.4% (8/155 vs 27/155; P < 0.001) for the thorax, 3.8% vs 30.6% (6/157 vs 48/157; P < 0.001) for the heart and 3.2% vs 23.6% (5/157 vs 37/157; P < 0.001) for the abdomen. For the spine, both techniques showed an equally low non-diagnostic rate. When both postmortem imaging techniques were diagnostic, they had similar accuracy, with no difference in sensitivity or specificity, and similar concordance with autopsy (PM-US, 79.5-96.5%; PM-MRI, 81.6-99.1%). CONCLUSIONS: PM-MRI performed significantly better than PM-US in this unselected population, due mainly to a lower non-diagnostic rate. PM-MRI should remain the first-line imaging investigation for perinatal autopsy, but PM-US could be considered if MRI is not available, albeit with a higher non-diagnostic rate. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Subject(s)
Autopsy/methods , Fetal Death/etiology , Fetus/diagnostic imaging , Magnetic Resonance Imaging/methods , Ultrasonography/methods , Abdomen/diagnostic imaging , Abortion, Induced/statistics & numerical data , Autopsy/statistics & numerical data , Autopsy/trends , Belgium/epidemiology , Brain/diagnostic imaging , Cause of Death , Female , Fetus/pathology , Gestational Age , Heart/diagnostic imaging , Humans , Magnetic Resonance Imaging/statistics & numerical data , Pregnancy , Prospective Studies , Sensitivity and Specificity , Spine/diagnostic imaging , Thorax/diagnostic imaging , Ultrasonography/statistics & numerical data
7.
Eur J Epidemiol ; 34(12): 1171-1174, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31728879

ABSTRACT

OBJECTIVE: Autopsy rates have been declining worldwide. The present study reports the outcome of a retrospective analysis of all non-forensic autopsies in the Netherlands over a course of 25 years, and compares these with the most recent Dutch study. METHOD: Retrospectively, 25 years of data on clinical autopsies from the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA) was paired with the mortality registry (Statistics Netherlands). RESULTS: The crude prevalence of autopsies declined from 7.07% in 1991 to 2.73% in 2015. After adjusting for age at death, there was no difference in autopsy rate between males and females. An increasing age significantly decreased the autopsy rate. CONCLUSION: In the Netherlands, clinical autopsies have been declining over the last quarter century. Age at death, but not sex, was associated with the autopsy rate. These different results stress the importance of correct collection and analysis methods of data.


Subject(s)
Autopsy/trends , Forensic Medicine/statistics & numerical data , Adolescent , Adult , Aged , Autopsy/statistics & numerical data , Cause of Death , Child, Preschool , Female , Forensic Medicine/trends , Hospital Mortality , Humans , Infant , Male , Middle Aged , Netherlands , Prevalence , Retrospective Studies , Young Adult
8.
J Korean Med Sci ; 34(47): e301, 2019 Dec 09.
Article in English | MEDLINE | ID: mdl-31808323

ABSTRACT

BACKGROUND: The autopsy is the medical examination of a deceased person that mainly provides information on the cause and manner of death. Two types are conducted in Korea: clinical and legal, depending on its purpose. Despite this procedure's importance, autopsy rates have been decreasing worldwide. The aim of this study was to determine the nationwide autopsy rate in Korea and compare it with that in other countries. METHODS: We collected data of autopsies performed between 2001 and 2015 by searching previously published literature on autopsy statistics and by requesting data from the relevant institutions. We calculated the autopsy rate by using mortality data from Statistics Korea; furthermore, we investigated the type of autopsy performed by institution as well as by geographical region. RESULTS: The total autopsy rate in Korea increased from 2.16% in 2001 to 2.60% in 2015. In terms of autopsy types, however, clinical autopsy rates decreased from 0.17% in 2001 to 0.03% in 2015, while legal autopsy rates increased from 1.99% to 2.57% during the same period. Moreover, the clinical autopsy rate tended to decrease throughout the period, while the legal autopsy rate fluctuated between 2001 and 2010 but steadily increased thereafter. CONCLUSION: The autopsy rate in Korea is lower compared to that of the advanced countries. These findings implicate the need for nationwide policy to promote both clinical and legal autopsy, which remain crucial parts of medical science and public health.


Subject(s)
Autopsy/statistics & numerical data , Autopsy/trends , Humans , Republic of Korea/epidemiology , Time Factors
9.
Fa Yi Xue Za Zhi ; 34(1): 49-54, 2018 Feb.
Article in Zh | MEDLINE | ID: mdl-29577705

ABSTRACT

Estimation of postmortem interval (PMI) plays a crucial role in forensic study and identification work. Because of the unique anatomy location, vitreous humor is considered to be used for estima- ting PMI, which has aroused interest among scholars, and some researches have been carried out. The detection techniques of vitreous humor are constantly developed and improved which have been gradually applied in forensic science, meanwhile, the study of PMI estimation using vitreous humor is updated rapidly. This paper reviews various techniques and instruments applied to vitreous humor detection, such as ion selective electrode, capillary ion analysis, spectroscopy, chromatography, nano-sensing technology, automatic biochemical analyser, flow cytometer, etc., as well as the related research progress on PMI estimation in recent years. In order to provide a research direction for scholars and promote a more accurate and efficient application in PMI estimation by vitreous humor analysis, some inner problems are also analysed in this paper.


Subject(s)
Autopsy , Forensic Pathology/trends , Postmortem Changes , Vitreous Body/metabolism , Autopsy/methods , Autopsy/trends , Body Fluids , Flow Cytometry , Humans , Potassium , Time Factors
10.
Fa Yi Xue Za Zhi ; 34(2): 165-170, 2018 Apr.
Article in Zh | MEDLINE | ID: mdl-29923384

ABSTRACT

Postmortem interval (PMI) estimation is one of the most challenging problems in the field of forensic science. Vitreous humor is a hotspot which has been used for PMI estimation and postmortem chemical analysis in forensic pathology. In order to provide novel perspectives for the future research of PMI estimation using vitreous humor, the comparison between vitreous humor with other common body fluids, the effect of temperature on vitreous humor, vitreous humor detection method and data fitting method have been reviewed in this paper.


Subject(s)
Autopsy , Forensic Pathology/trends , Forensic Sciences , Postmortem Changes , Vitreous Body/metabolism , Autopsy/methods , Autopsy/trends , Body Fluids , Humans , Potassium , Temperature , Time Factors , Vitreous Body/pathology
12.
Int J Legal Med ; 131(4): 1069-1083, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28439696

ABSTRACT

Part 1 of the review "Back to the Future" examines the historical evolution of the medico-legal autopsy and microscopy techniques, from Ancient Civilization to the Post-Genomic Era. In the section focusing on "The Past", the study of historical sources concerning the origins and development of the medico-legal autopsy, from the Bronze Age until the Middle Ages, shows how, as early as 2000 BC, the performance of autopsies for medico-legal purposes was a known and widespread practice in some ancient civilizations in Egypt, the Far East and later in Europe. In the section focusing on "The Present", the improvement of autopsy techniques by Friedrich Albert Zenker and Rudolf Virchow and the contemporary development of optical microscopy techniques for forensic purposes during the 19th and 20th centuries are reported, emphasizing, the regulation of medico-legal autopsies in diverse nations around the world and the publication of international guidelines or best practices elaborated by International Scientific Societies. Finally, in "The Future" section, innovative robotized and advanced microscopy systems and techniques, including their possible use in the bio-medicolegal field, are reported, which should lead to the improvement and standardization of the autopsy methodology, thereby achieving a more precise identification of natural and traumatic pathologies.


Subject(s)
Autopsy/history , Anatomy/history , Autopsy/trends , Forecasting , Forensic Pathology/history , Forensic Pathology/trends , Guidelines as Topic , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , History, Ancient , History, Medieval , Humans , Medicine in the Arts , Mummies/history , Museums , Textbooks as Topic/history
13.
Pathologe ; 38(5): 416-421, 2017 Sep.
Article in German | MEDLINE | ID: mdl-28752179

ABSTRACT

BACKGROUND: The number of autopsies has been steadily declining worldwide over the past decades. The reasons for this are diverse. Legislation regarding opposition and consent rules does not appear to have had a significant impact on the autopsy rates. Above all, structural causes and the attitude of the medical profession are the reasons for this decline. The main argument for a high autopsy rate is the identification of diagnostic errors; however, diagnostic discrepancies are relatively independent of the rate of autopsies performed. At the University Hospital (UniversitätsSpital) Zurich it could be shown in a study that from 1972-2002 the frequency of relevant diagnostic discrepancies (classes I and II) decreased from 30% to 7%. OBJECTIVE: The aim of this article is to present the necessity of a stable autopsy rate and to examine the situation of the autopsy in Switzerland. MATERIAL AND METHODS: For this purpose, the importance of autopsies in the fields of quality assurance of medical diagnostics, cancer statistics, medical research as well as further education of doctors in Switzerland is shown. Efforts are being made by the pathologists to counteract the declining autopsy rates. RESULTS AND DISCUSSION: Declining autopsy numbers have a significant influence on cancer statistics. The rate of newly discovered tumors in autopsies in Switzerland decreased from 42% in 1980 to 17% in 2010. Pediatric autopsies are an important tool for quality assurance of medical diagnostics in neonatology and pediatrics in Switzerland, but the rate of autopsies carried out is also declining. Postmortem magnetic resonance imaging (MRI) examinations (virtopsy) could increase the acceptance of the parents for an autopsy in the future. Autopsies make an important contribution in research and in documentation of therapy-associated side effects and they are an important component of further education of the upcoming medical generations.


Subject(s)
Autopsy/statistics & numerical data , Attitude of Health Personnel , Autopsy/trends , Diagnosis, Differential , Diagnostic Errors , Hospitals, University/statistics & numerical data , Humans , Prevalence , Switzerland
14.
Pathologe ; 38(5): 422-429, 2017 Sep.
Article in German | MEDLINE | ID: mdl-28842753

ABSTRACT

BACKGROUND: In 2015 the German professional Association of Pathologists conducted a survey to establish a baseline for an autopsy rate in Germany and to collect data from 2005-2014, as hospitals must meet a fixed autopsy quota to receive the supplementary payment for autopsies as stated in the law for hospital structure (KHSG 10.12.2015). MATERIAL AND METHODS: The survey comprised 12 questions and was sent to 450 institutes of pathology. The overall return rate was 38%. The data of the different institutional types was grouped and statistically analyzed. RESULTS: Of 86.416 reported autopsies on deceased adults in Germany from 2005-2014, 47% took place in university hospitals, 36% in local hospitals and 17% in privately run practices. Out of 4320 autopsies on deceased children and adolescents, the majority (83%) were performed at university hospitals, 8%, and 9%, respectively, at the other two entity types. Of the 14.047 fetal autopsies, 55% were done at university hospitals, 25% at other hospitals and 20% at private practices. From 2005 to 2014 the overall number of autopsies decreased by 30%, independently of the institute type. Within each group of institution types there was a wide range in numbers and rate of autopsies done per year: university hospitals total 0­428, quota of 3,4-19,4%; local hospitals 0­324, quota of 1,1-30,8%; private practices 0­268, quota 0,4-5,2%. CONCLUSION: To this day, there is no universal system to document and register hospital autopsy rates in Germany. Due to the high range of yearly autopsy rates even within the different groups of institute types, the threshold for the autopsy rate that must be met to obtain the supplementary payment should be low in the beginning.


Subject(s)
Autopsy/statistics & numerical data , Adolescent , Adult , Autopsy/trends , Child , Female , Fetus/pathology , Germany , Hospitals/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Pathology Department, Hospital/statistics & numerical data , Pregnancy , Prevalence , Surveys and Questionnaires
15.
Pathologe ; 38(5): 438-447, 2017 Sep.
Article in German | MEDLINE | ID: mdl-28741114

ABSTRACT

BACKGROUND: Fetal autopsy rates are decreasing in Western countries although post-mortem examinations render important information for the parents concerning the cause of abortion and risk of recurrence in future pregnancies. OBJECTIVE: The intention of the presented study was to analyze the development of fetal autopsies in Germany during the last decade and to review accessible information obtained by fetal autopsy. MATERIAL AND METHODS: Reports of fetal autopsies conducted in two German university Institutes of pathology between 2005 and 2014 were evaluated retrospectively. Demographic data and the correlation between clinical diagnoses and autopsy findings were assessed. In addition, differences between spontaneous and induced cases of abortion and differences between the institutes were also documented. RESULTS: Overall, 428 fetal autopsies were performed, whereby the number of autopsies decreased by 24.2% during the study period. Of the examined fetuses 29.7% were induced abortions which as expected exhibited different malformations compared to cases of spontaneous abortion (p < 0.001). There was no evidence of a malformation or other cause of death in 27.1% of the cases and 95.7% of these abortions occurred spontaneously. A discrepancy between clinical and autopsy findings was evident in 6.8% of cases and 3.5% of the autopsy examinations revealed at least one additional malformation compared to the prenatal clinical data. CONCLUSION: Despite improvements in prenatal diagnostics, fetal autopsies remain an important diagnostic tool even today contributing additional information in a considerable number of cases potentially revising clinical diagnoses.


Subject(s)
Autopsy/statistics & numerical data , Congenital Abnormalities/pathology , Fetal Death/etiology , Fetal Diseases/pathology , Fetus/pathology , Abortion, Spontaneous/pathology , Autopsy/trends , Cause of Death , Female , Germany , Humans , Infant, Newborn , Pregnancy , Prevalence , Recurrence , Risk Factors , Stillbirth
16.
Pathologe ; 38(5): 430-437, 2017 Sep.
Article in German | MEDLINE | ID: mdl-28698908

ABSTRACT

BACKGROUND: The clinical autopsy is the ultimate medical service for a patient and plays a crucial role in the education of physicians and other medical personnel, as well as in the context of quality control. Nevertheless, the number of autopsies is constantly decreasing. Numerous factors, such as the personal attitude of relatives and also clarification of relatives, as well as the increasing application of imaging methods while the patient is still alive, play a central role in this decline. OBJECTIVE: This study aimed to demonstrate the development of autopsy services over the past decade in two university hospitals in Germany and therefore to underline the importance of this investigation procedure in pathology. MATERIAL AND METHODS: Autopsy reports between the years 2005 and 2014 from 2 university institutes of pathology were analyzed regarding a diverse dataset, including age and sex of the deceased as well as the clinical and pathological causes of death. RESULTS: The data showed that the number of autopsies has continuously decreased over the past decade; however, the distribution of characteristics of the deceased remained relatively stable. In this cohort the clinically assumed cause of death differed from the pathological cause of death in 6% of the autopsies. Frequently occurring discrepant diagnoses were cardiac tamponade, aortic dissection and endocarditis/myocarditis. DISCUSSION: Our results show that, despite significant improvements in imaging methods, findings do not yield more accurate results than does autopsy. This underscores once again the need to encourage the performance of this final medical act on patients.


Subject(s)
Autopsy/statistics & numerical data , Hospitals, University/statistics & numerical data , Adult , Aortic Dissection/pathology , Attitude , Autopsy/trends , Cardiac Tamponade/pathology , Cause of Death , Cohort Studies , Datasets as Topic , Diagnostic Errors , Diagnostic Imaging/statistics & numerical data , Diagnostic Imaging/trends , Endocarditis/pathology , Germany , Hospitals, University/trends , Humans , Myocarditis/pathology , Prevalence , Quality Control
17.
Am J Ind Med ; 59(4): 307-14, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26901656

ABSTRACT

BACKGROUND: South African miners have a statutory right to autopsies for occupational lung disease compensation. These autopsies also provide information for research and surveillance. METHODS: Cardio-respiratory organs are removed where miners die and are examined at the National Institute for Occupational Health. We extracted data from the PATHAUT database and described key demographic, exposure and disease trends (1975-2013). RESULTS: Of 109,101 autopsies, 72,348 (66.3%) were black, and 34,794 (31.9%) were white miners. Autopsies declined from over 3,000 (1975-1998) to 1,118 in 2013. Most were gold miners (74.0%). 78.6% black and 13.2% white miners died while in employment. Overall proportions of silicosis and pulmonary tuberculosis were 12.0% and 13.0% in black, and 20.5% and 2.4% in white miners, respectively. Disease increased over time. CONCLUSIONS: High levels of disease persist. Black ex-miners are underrepresented, indicating a need for strategies to improve awareness and provision of autopsy facilities in labor-sending areas.


Subject(s)
Lung Diseases/mortality , Mining/statistics & numerical data , Occupational Diseases/mortality , Adult , Autopsy/statistics & numerical data , Autopsy/trends , Black People/statistics & numerical data , Female , Gold , Humans , Lung Diseases/etiology , Male , Middle Aged , Occupational Diseases/etiology , Silicosis/etiology , Silicosis/mortality , South Africa/epidemiology , Tuberculosis, Pulmonary/etiology , Tuberculosis, Pulmonary/mortality , White People/statistics & numerical data , Young Adult
18.
Forensic Sci Med Pathol ; 12(1): 68-80, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26820284

ABSTRACT

Iatrogenic deaths are a concern for patients, physicians, and public health specialists. Most medicolegal investigation jurisdictions in the United States have the legal authority and mandate to investigate deaths associated with diagnostic/therapeutic procedures. Given the decreasing trends of autopsies performed in U.S. hospitals, forensic pathologists are likely to take on an even greater role in investigating these deaths. This is an overview and forensic pathological approach to fatal complications due to diagnostic and therapeutic medical events.


Subject(s)
Cause of Death , Iatrogenic Disease , Anesthesia/adverse effects , Autopsy/statistics & numerical data , Autopsy/trends , Cross Infection/complications , Death Certificates , Drug-Related Side Effects and Adverse Reactions , Forensic Pathology , Humans , Professional Role , Pulmonary Embolism/etiology , Renal Dialysis/adverse effects , Surgical Procedures, Operative/adverse effects , Transfusion Reaction
19.
Sud Med Ekspert ; 59(2): 47-54, 2016.
Article in Russian | MEDLINE | ID: mdl-27358930

ABSTRACT

We undertook the analysis of the foreign publications concerning the application of the modern radiodiagnostic methods (including MSCT- and MRI-visualization) with reference to the solution of the traditional problems facing forensic medical expertise, such as the estimation of prescription of death coming and time of infliction of injury in the dead bodies. Both advantages and disadvantages of postmortem visualization of the corpses of adult subjects are discussed taking into consideration the period of time that elapsed between the death and the onset of the study as well as the character of the injuries. It was shown that the examination of the corpses using the up-to-date methods of radiodiagnostics prior to autopsy makes it possible for morphologists, jointly with radiologists, to identify, to see in the new light, and to evaluate the number of charges in the dead body, such as the alteration of the blood cell sedimentation rate, the formation of postmortem hypostases in the internal organs, the hardening of the walls of aorta and major blood vessels, right heart dilatation, gradual smoothing of the borderline between grey and white matter of the brain. Virtual autopsy can be useful , even for the study of such long-term processes in the corpses as putrefaction, saponification, mummification, and peat tanning. Moreover, this technique may be instrumental in the elucidation of the specific features of topographic-anatomical relationships between individual 'tissues and organs, detection of the concealed lesions, and a variety of pathological changes. Postmortem visualization allows for the quantitative evaluation of the severity of these transformations and the preliminary estimation of prescription of death coming. Also, radiodiagnostic methods can be employed to reliably visualize and measure various hemorrhagic events (from the density of such ones as liquid and clotted blood) in the tissues surrounding the fractures, in body cavities, and internal organs as well as to establish the facts of inter-vital aspiration of blood, alimentary masses, liquid and solid foreign bodies penetrating into the upper sections of the respiratory and gastrointestinal tracts as the consequence f an injury. It is concluded that the postmortem visualization techniques employed to estimate prescription of death coming and time of infliction of injury as well as other complicated problems facing forensic medical expertize need the further scientifically based development.


Subject(s)
Autopsy , Adult , Autopsy/instrumentation , Autopsy/methods , Autopsy/trends , Forensic Pathology/methods , Forensic Pathology/trends , Humans , Magnetic Resonance Imaging/methods , Postmortem Changes , Tomography, X-Ray Computed/methods
20.
Pediatr Radiol ; 45(4): 509-16, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25828354

ABSTRACT

The field and applications of postmortem imaging are exponentially growing. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented, as well as its use in drug mule identification. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. In this review, after a short historical review and analysis of current problems and challenges, we will try to depict the way we see the future of this subspecialty of postmortem cross-sectional imaging, including all specific situations: terminations of pregnancy, intrauterine death, sudden unexpected infant death and identification issues.


Subject(s)
Autopsy/trends , Diagnostic Imaging/trends , Forecasting , Pediatrics/trends , Prenatal Diagnosis/trends , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , United States
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