Impact of changing from autopsy to post-mortem CT in an entire HM Coroner region due to a shortage of available pathologists.

A significant problem facing routine medicolegal coroner-referred autopsies is a shortfall of pathologists prepared to perform them. This was particularly acute in Lancashire, where the coroner decided to initiate a service that relied on post-mortem computed tomography (PMCT). This involved training anatomical pathology technologists (APTs) to perform external examinations, radiographers to perform scans, and radiologists to interpret them. The service started in 2018 and now examines over 1,500 cases per year. This study outlines the PMCT process using NHS staff, with CT equipment and logistics managed by the commercial sector. It compares the demographics and outcomes of PM investigations for two 6-month periods: the autopsy service prior to 2018, and then the PMCT service. These data were then compared with previous UK PMCT data. Referrals for adult non-suspicious deaths were made in 913 cases of which 793 (87%) had PMCT between 01/10/2018 and 31/03/2019. Fifty-six cases had autopsy after PMCT, so 81% of cases potentially avoided autopsy. The PMCT service did not delay release of bodies to the next-of-kin. Comparing the cause of death given shows no difference in the proportions of natural and unnatural deaths. There was an increase in diagnosis of coronary artery disease for PMCT, with less respiratory diagnoses, a feature not previously demonstrated. These data suggest PMCT is a practical solution for potentially failing autopsy services. By necessity, this involves changes in diagnoses, as PMCT and autopsy have different strengths and weakness, but the ability to pick up unnatural death appears unaffected.

Using taphonomy to infer differences in soft tissues between taxa: an example using basal and derived forms of Solnhofen pterosaurs.

In fossilised vertebrates, the presence of soft tissues is the most obvious way to determine aspects of anatomy and functional morphology; however, occurrences are rare and other lines of evidence must be sought to indicate its extent and strength. For example, pterosaurs possessed a large wing membrane that enabled powered flight but other tissues are not widely preserved. A semi-quantitative analysis comparing skeletal articulation and completeness of the pterodactyloid Pterodactylus and non-pterodactyloid pterosaur Rhamphorhynchus from Solnhofen-type deposits implies there were anatomical differences between soft-tissue structure and attachments articulating skeletal joints of each. Typically, skeletons of Pterodactylus disarticulate to a greater extent than those of Rhamphorhynchus, which in turn suggests decay progressed to more advanced states in the former. However, this generalisation masks a mosaic of differences between different body parts, for example Rhamphorhynchus tends to lose the wings as complete units but retains a complete and still articulated tail in a greater number of specimens than Pterodactylus.

Role of hip arthrodesis in current practice: long term results following conversion to total hip arthroplasty.

BACKGROUND: Hip arthrodesis was once considered as a preferred treatment option in young people with hip arthritis. The purpose of this retrospective study was to evaluate the long term outcome following conversion of hip arthrodesis to arthroplasty. The main indications for conversion were back pain and ipsilateral muscular or knee pain. METHODS: Sixty-eight procedures in 67 patients performed between 1963 and 2000 at Wrightington Hospital were evaluated. RESULTS: The mean age at the time of hip arthrodesis was 16.7 years (3 to 39 years). The mean age at the time of conversion was 48.7 years (24 to 74 years). The Merle d'Aubigné score improved from a mean of 8.81 pre-operatively to 13.6 at the latest follow-up. Complications included DVT (3 patients), transient foot drop (1 patient), and hepatitis following blood transfusion (1 patient). Seven patients required further revision surgery following conversion. CONCLUSIONS: Arthrodesis remains a sensible and safe treatment option maintaining independent mobility without multiple operations or significant bone loss for 20-30 years which subsequently can be successfully converted to an arthroplasty.