Fatores associados ao tempo da morte de vítimas de trauma: estudo de coorte retrospectivo / Factores asociados al momento de la muerte de víctimas de traumatismos: estudio de cohorte retrospectivo / Factors associated to the time of death of trauma victims: A retrospective cohort study

Objetivo: identificar os fatores associados ao tempo da morte de vítimas de trauma. Método: coorte retrospectiva que analisou laudos de autópsia de vítimas de trauma admitidas em 2015 no Instituto Médico Legal Central de São Paulo, Brasil. O tempo da morte foi identificado a partir do momento da ocorrência do trauma até a confirmação do óbito. O modelo linear generalizado foi aplicado para análise dos dados. Resultados: entre as 1.500 vítimas fatais (75,7% homens; idade média 49,7 anos), prevaleceram as quedas (33,5%), seguidas das agressões (27,8%). Os fatores associados ao tempo da morte foram número de regiões corporais afetadas (p<0,001), tipo de trauma (p<0,001), sexo (p=0,009), gravidade do trauma segundo New Injury Severity Score (p<0,001), agressões (p<0,001) e lesões autoprovocadas intencionalmente (p<0,001). Conclusão: mulheres, vítimas de traumas que envolveram intencionalidade de provocar a morte e com elevada gravidade apresentaram tempo de sobrevida reduzido após a(s) lesão(ões).

Objective: to identify factors associated to the time of death of trauma victims. Method: a retrospective cohort that analyzed autopsy reports of trauma victims admitted in 2015 at the Central Institute of Forensic Medicine of São Paulo, Brazil. The time of death was identified from the trauma moment to the confirmation of death. The generalized linear model was applied to analyze the data. Results: among the 1,500 fatal victims (75.7% were men; mean age of 49.7 years old), falls prevailed (33.5%), followed by aggressions (27.8%). The factors associated with the time of death were the number of body areas affected (p<0.001), type of trauma (p<0.001), gender (p=0.009), trauma severity according to the New Injury Severity Score (p<0.001), assaults (p>0.001), and intentionally self-harm injuries (p<0.001). Conclusion: women, victims of traumas with the intention of causing death and with high severity presented a reduced survival time after the injury(ies).

Objetivo: identificar los factores asociados al momento de la muerte de víctimas de traumatismos. Método: estudio de cohorte retrospectivo que analizó informes de autopsias de víctimas de traumatismos admitidas en 2015 en el Instituto Médico Legal Central de San Pablo, Brasil. El momento de la muerte se identificó a partir del momento en que sucedió el traumatismo hasta la confirmación de la muerte. Se aplicó el modelo lineal generalizado para el análisis de los datos. Resultados: entre las 1.500 víctimas fatales (75,7% de ellas hombres; media de edad de 49,7 años), prevalecieron las caídas (33,5%), seguidas por las agresiones (27,8%). Los factores asociados al momento de la muerte fueron la cantidad de áreas del cuerpo afectadas (p<0,001), el tipo de traumatismo (p<0,001), el sexo (p=0,009), la gravedad del traumatismo conforme al New Injury Severity Score (p<0,001), agresiones (p<0,001) y lesiones autoprovocadas intencionalmente (p<0,001). Conclusión: las mujeres, víctimas de traumatismos con intención de provocar la muerte y de alta gravedad presentaron un tiempo de sobrevida reducido después de la o las lesiones.

The grim reaper evading modern medicine: aspergillosis, adenovirus, and Hodgkin lymphoma

Illustrative cases of diseases that are difficult to suspect and diagnose can serve as useful reminders. Invasive pulmonary aspergillosis and adenovirus hepatitis are two such diseases, both revealed by autopsy in this case of Hodgkin lymphoma refractory to chemotherapy treated with allogeneic hematopoietic stem cell transplantation complicated by these two fatal infections. This patient was cured of Hodgkin lymphoma, Clostridioides difficile colitis and thrombotic thrombocytopenic purpura using the marvels of modern medicine. This case illustrates many features of aspergillosis and adenovirus hepatitis, shows the value of autopsy in revealing diagnoses, and illustrates the limits of modern medicine, which should serve as a mental spur in our efforts to advance medical science, to try to defeat the numerous demons of disease, who seem to keep outwitting us.

Mortality in adolescents and young adults with chronic diseases during 16 years: a study in a Latin American tertiary hospital / Mortalidade entre adolescentes e adultos jovens com doenças crônicas durante 16 anos: estudo em um hospital terciário da América Latina

ABSTRACT Objectives: To evaluate mortality in adolescents and young adult patients with chronic diseases followed in a Latin American tertiary hospital. Methods: A cross-sectional retrospective study was performed in a tertiary/academic hospital in the state of São Paulo, Brazil. Death occurred in 529/2850 (18.5%) adolescents and young adult patients with chronic diseases, and 25/529 (4.7%) were excluded due to incomplete medical charts. Therefore, 504 deaths were evaluated. Results: Deaths occurred in 316/504 (63%) of early adolescent patients and in 188/504 (37%) of late adolescent/young adult patients. Further comparisons between early adolescents (n = 316) and late adolescent/young adult patients (n = 188) with pediatric chronic diseases at the last hospitalization showed that the median disease duration (22.0 [0-173] vs. 43.0 [0-227] months, p < 0.001) was significantly lower in early adolescents vs. late adolescent/young adult patients. The median number of previous hospitalizations was significantly lower in the former group (4.0 [1-45] vs. 6.0 [1-52], p < 0.001), whereas the last hospitalization in intensive care unit was significantly higher (60% vs. 47%, p = 0.003). Regarding supportive measures, palliative care was significantly lower in the younger group compared to the older group (33% vs. 43%, p = 0.02). The frequencies of renal replacement therapy (22% vs. 13%, p = 0.02), vasoactive agents (65% vs. 54%, p = 0.01), and transfusion of blood products (75% vs. 66%, p = 0.03) were significantly higher in the younger group. The five most important etiologies of pediatric chronic diseases were: neoplasias (54.2%), hepatic diseases/transplantation (10%), human immunodeficiency virus (5.9%), and childhood-onset systemic lupus erythematosus and juvenile idiopathic arthritis (4.9%). Autopsy was performed in 58/504 (11%), and discordance between clinical and postmortem diagnoses was evidenced in 24/58 (41.3%). Conclusions: Almost 20% of deaths occurred in adolescents and young adults with distinct supportive care and severe disease patterns. Discordance between clinical diagnosis and autopsy was frequently observed.

RESUMO Objetivos: Avaliar a mortalidade entre adolescentes e pacientes adultos jovens com doenças crônicas acompanhados em um hospital terciário na América Latina. Métodos: Foi feito um estudo retrospectivo transversal em um hospital terciário/universitário no Estado de São Paulo, Brasil. Houve mortalidade de 529/2.850(18,5%) pacientes adolescentes e adultos jovens com doenças crônicas, porém 25/529(4,7%) foram excluídos devido a prontuários médicos incompletos. Portanto, foram avaliados 504 óbitos. Resultados: Ocorrem 316/504(63%) óbitos entre pacientes no início da adolescência e 188/504(37%) pacientes no fim da adolescência/adultos jovens. As comparações adicionais entre os pacientes no início da adolescência (n = 316) e no fim da adolescência/pacientes jovens (n = 188) com doenças crônicas pediátricas na última internação mostraram que a duração média da doença [22,0 (0-173) em comparação com 43,0 (0-227) meses, p < 0,001], foi significativamente menor nos pacientes no início da adolescência em comparação com os pacientes no fim da adolescência/adultos jovens. O número médio de internação anterior foi significativamente menor no primeiro grupo [4,0 (1-45) em comparação com 6,0 (1-52), p < 0,001], ao passo que a última internação na unidade de terapia intensiva foi significativamente maior (60% em comparação com 47%, p = 0,003). Com relação a medidas de suporte, o cuidado paliativo foi significativamente menor no grupo de pacientes no início da adolescência em comparação com o grupo de pacientes no fim da adolescência (33% em comparação com 43%, p = 0,02). As frequências de terapia de substituição renal (22% em comparação com 13%, p = 0,02), agentes vasoativos (65% em comparação com 54%, p = 0,01) e transfusão de hemoderivados (75% em comparação com 66%, p = 0,03) foram significativamente maiores no primeiro grupo. As cinco etiologias mais importantes de doenças crônicas pediátricas foram: neoplasias (54,2%), doenças hepáticas/transplante (10%), vírus da imunodeficiência humana (5,9%), lúpus eritematoso sistêmico de início na infância e artrite idiopática juvenil (4,9%). Foi feita autópsia em 58/504 (11%) e a discordância entre os diagnósticos clínico e pós-morte foi comprovada em 24/58 (41,3%). Conclusões: Quase 20% dos óbitos ocorreram em adolescentes e adultos jovens com diferentes padrões de cuidados de suporte e doenças graves. A discordância entre o diagnóstico clínico e a necropsia foi frequentemente observada.

Mortalidad prenatal en el Centro Hospitalario Pereira Rossell, Montevideo. Análisis de 845 casos de autopsia entre 2005 y 2016 / Stillbirth at Pereira Rossell Hospital in Montevideo. Analysis of 845 autopsies between 2005 and 2016

Resumen: Antecedentes: con la mejora de la atención del embarazo se ha reducido el número de mortinatos en el mundo desarrollado. Pero en los países subdesarrollados y en vías de desarrollo constituyen un problema sanitario. Objetivo: conocer las patologías que subyacen en los casos de autopsia de mortinatos del Centro Hospitalario Pereira Rossell, a los efectos de contribuir a la reducción de la mortalidad fetal. Material y método: se realiza un estudio observacional, descriptivo de recolección de información en forma retrospectiva de las autopsias de los de mortinatos del Centro Hospitalario Pereira Rossell de los últimos 12 años (2005-2016). Las autopsias y las placentas fueron realizadas de acuerdo al protocolo habitual en patología perinatal. Los datos del estudio se analizaron conjuntamente. Resultados: se constataron malformaciones congénitas en 17,7% e infección congénita en la autopsia en 20,4%. La infección en conjunto (en autopsia y/o placenta) se identificó en 383 casos (45,3%). Se identificó lúes en 10,5% de los mortinatos. Había elementos fetales de asfixia en 11,5% y una miscelánea de patologías en 3,5% de los casos. En 50,4% la autopsia propiamente dicha no tenía alteraciones, pero en 90% de ellas se identificaron lesiones placentarias que pudieron ser responsables de la muerte fetal. Se observó bajo flujo sanguíneo útero placentario en 14,2% de las placentas, corioamnionitis en 30,5% de las placentas, y hematoma retroplacentario en 26,6% de las placentas. La muerte fue indeterminada en 4,9% de los casos. Conclusiones: un elevado porcentaje de los casos tienen patologías evitables y tratables. Se identificaron patologías potencialmente recurrentes y enfermedades que ameritan tratar a la madre. Los estudios de los mortinatos deben ser considerados en los protocolos sanitarios a los efectos de reducir la mortalidad fetal.

Summary: Background: the number of stillbirth cases has been reduced in the developed countries due to improvements in pregnancy care. It is important to know the causes in order to prevent fetal death. Early identification of risk factors for stillbirth may reduce the number of cases. The objective of this paper is to identify the underlying pathologies of the cases that underwent an autopsy at Pereira Rossell Hospital in Montevideo, in order to contribute to the reduction of fetal mortality. Methods: this is a retrospective and descriptive study of autopsy and placental examinations, performed at the Pediatric Pathology Laboratory of Pereira Rossell Hospital in Montevideo. A standard protocol was applied. Data were analyzed overall. Results: congenital malformations were identified in 17.7% of cases; congenital infection in the fetus was found in 20.4%. Infection altogether (in the autopsy and/or the placenta) was identified in 383 cases (45.3%). Syphilis was diagnosed in 10.5% of the stillborn. Fetal evidence of asphyxia accounted for 11.5% and miscellaneous pathologies 3.5%. In 50.4% of cases the autopsy did not reveal alterations, but 90% of corresponding placentas had lesions that could have caused the death of the fetus. Maternal underperfusion or malperfusion was found in 14.2% of the placentas. Chorioamnionitis was seen in 30.5%. A retroplacental hematoma was seen in 26.6%. Stillbirth was of unexplained in 4.9% of the cases. Conclusion: a high percent of the cases studied had a preventable pathology. Many recurrent lesions were identified as well as cases that required additional medication to the mother. The results of the pathology examination should be considered in order to reduce the stillbirth rate.

Caracterización anatomopatológica de los neonatos fallecidos durante el quinquenio 2010-2014 / Pathological characterization of dead neonates during 2010-2014

Se realizó un estudio transversal y retrospectivo de los 55 neonatos autopsiados en el Departamento de Anatomía Patológica del Hospital General Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el quinquenio 2010-2014, para identificar las características anatomopatológicas que permitieran determinar las causas de las defunciones y describir los factores maternos y neonatales concurrentes en estas últimas. Entre los principales hallazgos sobresalió el predominio de estos decesos en el 2010, con 16; del sexo masculino (61,81 por ciento); de la muerte neonatal precoz con 32, de los nacidos pretérmino con bajo peso (94,44 por ciento), del parto por cesárea y de la preclampsia como antecedente materno. La causa básica de muerte más frecuente fue nacer antes del término con bajo peso en 30; y la causa directa de muerte, la hipoxia en 15 de ellos

A cross-sectional and retrospective study of the 55 neonates undergoing autopsy was carried out in the Pathology Department of Dr Juan Bruno Zayas Alfonso General Hospital in Santiago de Cuba, during 2010-2014, to identify the pathological characteristics that allowed to determine the causes of deaths and to describe the maternal and neonatal concurrent factors in the latter. Among the main findings the prevalence of these deaths in 2010 was significant, with 16; from male sex (61.81 percent); 32 with neonatal early death, of preterm birth with low birth weight (94.44 percent), of Caesarean delivery and of pre-eclampsia as maternal history. The most frequent basic cause of death was being born before term with low weight in 30 neonates; and the direct cause of death, hypoxia in 15 of them

Severe pulmonary hypertension due to combined pulmonary fibrosis and emphysema: another cause of death among smokers

In 2005, the combined pulmonary fibrosis and emphysema (CPFE) was first defined as a distinct entity, which comprised centrilobular or paraseptal emphysema in the upper pulmonary lobes, and fibrosis in the lower lobes accompanied by reduced diffused capacity of the lungs for carbon monoxide (DLCO). Recently, the fibrosis associated with the connective tissue disease was also included in the diagnosis of CPFE, although the exposure to tobacco, coal, welding, agrochemical compounds, and tire manufacturing are the most frequent causative agents. This entity characteristically presents reduced DLCO with preserved lung volumes and severe pulmonary hypertension, which is not observed in emphysema and fibrosis alone. We present the case of a 63-year-old woman with a history of heavy tobacco smoking abuse, who developed progressive dyspnea, severe pulmonary hypertension, and cor pulmonale over a 2-year period. She attended the emergency facility several times complaining of worsening dyspnea that was treated as decompensate chronic obstructive pulmonary disease (COPD). The imaging examination showed paraseptal emphysema in the upper pulmonary lobes and fibrosis in the middle and lower lobes. The echo Doppler cardiogram revealed the dilation of the right cardiac chambers and pulmonary hypertension, which was confirmed by pulmonary trunk artery pressure measurement by catheterization. During this period, she was progressively restricted to the minimal activities of daily life and dependent on caregivers. She was brought to the hospital neurologically obtunded, presenting anasarca, and respiratory failure, which led her to death. The autopsy showed signs of pulmonary hypertension and findings of fibrosis and emphysema in the histological examination of the lungs. The authors highlight the importance of the recognition of this entity in case of COPD associated with severe pulmonary hypertension of unknown cause.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients / Implicações da doença hepática alcoólica na aterosclerose de pacientes autopsiados

Summary Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Resumo Introdução: O alcoolismo é um grande problema de saúde pública, de elevado custo social e que afeta vários aspectos da atividade humana. Hepatopatia é uma das primeiras consequências do abuso de álcool, podendo ocorrer esteatose, cirrose hepática e hepatite. Outros órgãos, porém, também são afetados, ocorrendo alterações patológicas, como pancreatite, cardiomiopatias, dislipidemias e aterosclerose. Objetivo: Identificar a ocorrência e a intensidade de aterosclerose em alcoolistas com cirrose hepática, observando alterações macro e microscópicas do depósito lipídico e de fibras colágenas e fígado. Verificar a associação de depósito lipídico e de fibras colágenas com gênero, idade e índice de massa corporal (IMC). Relacionar alcoolismo, cirrose hepática e aterosclerose. Método: Foi realizado estudo com base em laudos de autópsias de pacientes com cirrose hepática alcoólica, sendo estudados aortas e fígados para verificar a ocorrência e a intensidade de aterosclerose, bem como a quantidade de colágeno encontrada. Resultados: A aterosclerose microscópica foi maior em jovens (lesão inicial) e em pacientes com cirrose hepática alcoólica. A análise macroscópica da aterosclerose nas aortas mostrou que pacientes com faixas etárias mais avançadas apresentaram classificações mais intensas. A aterosclerose, tanto micro quanto macroscopicamente, e a porcentagem de fibrose no fígado e na aorta foram mais expressivas no gênero feminino. Conclusão: Os pacientes cirróticos apresentaram maior porcentagem de fibrose e lipidose, e podem representar um grupo susceptível à acelerada progressão de doenças cardiovasculares. Estudos investigativos contribuem para o direcionamento das intervenções promotoras da saúde, reduzindo a mortalidade e os custos no tratamento das doenças cardiovasculares.

Estudo transversal dos óbitos provocados por trauma nos membros necropsiados no Instituto Médico Legal de Belo Horizonte, 2006 - 2011 / Imprimir PDF Estatísticas ARTIGO ORIGINAL Estudo transversal dos óbitos provocados por trauma nos membros necropsiados no Instituto Médico Legal de Belo Horizonte, 2006 - 2011 Cross-sectional study of trauma deaths caused by extremity trauma necropsied at the Forensic Medicine Institute of Belo Horizonte, 2006 - 2011

Introdução: Nos países industrializados, o trauma é a terceira causa de mortalidade, sendo a principal entre menores de 45 anos de idade. Em Belo Horizonte (BH), no ano de 2015, quase metade das hospitalizações relacionadas a causas externas se deveu por trauma nos membros. Entretanto, a epidemiologia do trauma fatal de extremidades em nosso meio é ainda pouco conhecida. Objetivos: Avaliar os óbitos decorrentes de trauma nos membros ocorridos em BH e região metropolitana para se estabelecer o perfil das vítimas e dos subtipos deste trauma. Métodos: Estudo transversal dos casos necropsiados no Instituto Médico Legal de BH no período de 2006 a 2011 cuja causa do óbito tenha sido trauma nos membros. Resultados: Foram recuperados 128 casos. Quanto aosmecanismos de trauma, a maioria se deveu a ação contundente, seguida pela ação pérfurocontundente. O ano de 2007, o mês de outubro e o domingo apresentaram maior proporção de necropsias. A maioria dos necropsiados era homem, possuía menos de 49 anos, era solteira, feoderma e ativa do ponto de vista ocupacional. Em quase metade dos casos havia suspeita de homicídio e a maioria das vítimas foi encaminhada de uma unidade de saúde. Conclusões: A caracterização mais detalhada dos óbitos decorrentes de trauma nos membros ocorridos em BH pode fornecer informações de saúde pública importantes para o direcionamento de recursos e delineamento de prioridades para redução das fatalidades. (AU)

Introduction: In industrialized countries, trauma is the third leading cause of mortality, with the highest rate in the young. In Belo Horizonte, nearly half of hospitalizations related to external causes were due to limb trauma. However, the epidemiology of fatal trauma caused by trauma in extremities in our setting is still poorly understood. Objectives: To evaluate the limb trauma related deaths occurred in BH and metropolitan area in order to establish the profile of the victims and the subtypes of this trauma. Methods: Cross-sectional study of the necropsy reports performed at IML/BH from 2006 to 2011, caused by limb trauma. Results: 128 reports of fatal limb trauma victims were recovered during the study period. Concerning the mechanisms of trauma, the majority was due to blunt trauma, followed by gunshot wounds. The year 2007, October and Sunday had a higher proportion of necropsies. Most victims were male, younger than 49 years old, were single, feoderm and active from an occupational point of view. In almost half of the cases, homicide was suspected. Most of the cases had trauma in the lower limbs and were referred from a health unit. Conclusions: The more detailed characterization of limb trauma related deaths in BH can provide important public health information for resource allocation and delineation of priorities for fatalities reduction. (AU)

The Lowest Prevalence of Cholelithiasis in the Americas - An Autopsy-based Study

OBJECTIVES: This study used autopsy to evaluate the prevalence of cholelithiasis and its associated risk factors in a population of healthy, young subjects who suffered a violent or natural death. METHODS: This study is a prospective evaluation of autopsies of 446 individuals from 2011 to 2013 in Brazil. Of that sample, 330 (74%) subjects died from violent deaths and 116 (26%) died naturally. The presence of biliary calculi, previous cholecystectomy, gender, age, ethnicity, body mass index (BMI) and alcohol use were evaluated. RESULTS: In the natural death group, 6.9% (95% CI 3.39 to 13.28) (3.08% of the male subjects and 11.76% of the female subjects) exhibited evidence of gallbladder disease. In the violent death group, only 2.12% (95% CI 0.96 to 4.43) (2.17% of the male subjects and 1.85% of the female subjects) of the subjects exhibited evidence of gallbladder disease. Age was correlated with the prevalence of gallbladder disease, but BMI was correlated with only gallbladder disease in the natural death group. CONCLUSIONS: This population has the lowest prevalence of cholelithiasis in the Americas. Dietary habits, physical activity, ethnicity, alcohol consumption and genetic factors may be responsible for this low prevalence.

Autopsias pediátricas / Pediatric autopsies

INTRODUCCIÓN: LA autopsia es una herramienta útil que garantiza el estudio más completo del enfermo y la enfermedad, y evalúa la calidad del trabajo médico. El estudio de las autopsias pediátricas ofrece un importante volumen de información. OBJETIVO: demostrar la utilidad de la autopsia para la evaluación de la calidad de la atención médica pediátrica. MÉTODOS: estudio retrospectivo longitudinal. Se estudiaron 363 autopsias pediátricas realizadas en el Hospital Militar Central "Dr. Luis Díaz Soto", desde su inauguración en 1962 hasta el 2011, a través del empleo del Sistema Automatizado de Registro y Control en Anatomía Patológica. RESULTADOS: predominó el sexo masculino (56,1 %) y el grupo etario más frecuente correspondió al de 28 días a un 1 año (70,8 %). Las principales causas básicas de muerte fueron por infecciones digestivas, respiratorias y cerebrales. La principal causa directa e intermedia de muerte fue el tromboembolismo pulmonar. La discrepancia clínico patológica fue de un 14,7 % en la causa básica y de 10,3 % en la causa directa de muerte. CONCLUSIONES: el trabajo científico combinado en 50 años de las especialidades de pediatría y anatomía patológica, demostró la utilidad de la autopsia para evaluar la calidad del trabajo médico y el apoyo que brinda el Sistema Automatizado de Registro y Control de Anatomía Patológica.

INTRODUCTION: autopsy is a useful tool to guarantee the most complete study of the sick person and of the disease, and to evaluate the quality of the physician's work. The study of pediatric autopsies provides a huge volume of information. OBJECTIVE: to prove the usefulness of autopsy for the evaluation of the quality of pediatric medical care. METHODS: retrospective longitudinal study of 363 pediatric autopsies conducted at "Luis Diaz Soto" central military hospital since its opening in 1962 through 2011. To this end, the Automated System of Registration and Control in Pathological Anatomy was used. RESULTS: predominance of males (56.1 %) and of the group aged 28 days to one year (70.8 %). The main causes of death were digestive, respiratory and brain infections. The main direct and intermediate cause of death was pulmonary thromboembolism. The clinical and pathological discrepancy was 14.7% in the main cause and 10.3 % in the direct cause of death. CONCLUSIONS: the combined scientific work in 50 years by the pediatrics and pathological anatomy specialties proved the usefulness of autopsy to evaluate the quality of the physician's work and the support given by the Automated System of Registration and Control of Pathological Anatomy.

Fatores de risco relacionados com suicidios em Palmas (TO), Brasil, 2006-2009, investigados por meio de autopsia psicossocial / Risk factors associated with suicides in Palmas in the state of Tocantins, Brazil, between 2006 and 2009 investigated by psycho-social autopsy

Este artigo objetiva analisar e descrever os fatores de risco e seus determinantes, associados a 24 casos de suicídios ocorridos na cidade de Palmas (TO), no período de 2006 a 2009. Utilizou-se o método de autópsia psicológica e psicossocial, a qual, por meio de entrevistas com familiares, busca investigar os suicídios consumados, contextualizando características da vida do sujeito, e compreender os processos familiares e as circunstâncias afetivas, sociais, econômicas e culturais, fundamentando-se na reconstrução da história e da personalidade da pessoa. Os fatores socioeconômicos associados foram: ser do sexo masculino, solteiro, de cor parda, estar na faixa etária de 20 a 40 anos e com ensino fundamental. Os principais fatores de risco identificados foram: transtornos mentais, abuso de álcool e outras drogas, relacionamento familiar conturbado e histórico de tentativas anteriores. Buscamos contextualizar e refletir sobre alguns casos relatados pelos familiares e sobre a resposta das equipes de saúde às demandas das famílias. A necessidade de implantar programas de prevenção e de capacitar os profissionais da atenção básica foi verificada. .

The scope of this article is to analyze and describe the risk factors and determinants linked to 24 suicides in the city of Palmas in the state of Tocantins between 2006 and 2009. The psychological and psycho-social autopsy method was used in order to investigate the consummated suicides by interviewing family members. It contextualized the subjects' life characteristics to understand the family dynamics and the affective, social, economic and cultural background, based on the reconstruction of the history and personality of the individuals. The associated socio-economic factors were: being male, aged between 20 and 40, single, with mixed ethnicity and basic education. The major risk factors identified were: mental disorder, alcohol and other drug abuse, disturbed family relationship and a history of previous suicide attempts. An attempt was made to contextualize and reflect on some cases reported by family members, as well as on the response of the health care teams to the demands of the families. The need to implement prevention programs and to train the primary health care professionals was considered a priority. .

Academic autopsies in Brazil - a national survey / Autópsias acadêmicas no Brasil - um inquérito nacional

Objective: To investigate the number and rate of academic autopsies, general organization, educational and research in Brazilian academic services. Methods: Standardized questionnaires were sent to Brazilian medical schools (n=177) and active pathology residency programs (n=53) from March to June 2009. Data were collected for years 2003 to 2008. Results: Thirty-two academic services in 11 Brazilian states answered the survey. Twenty-one (65.6%) perform less than a hundred autopsies for natural causes and less than fifty pediatric or fetal autopsies/year. Twenty-four (75%) perform less than a hundred adult autopsies/year. Many institutions (46.9%) reported a drop in the number of autopsies in a six-year period. The total autopsy count and autopsy rate in 2008 ranged 1-632 (median = 80), and 0-66% (mean = 10.6%), respectively. A steady decrease in the total count of autopsies in a pool of 19 institutions was observed (p<0.01). Median autopsy rates have fallen from 19.3%, in 2003, to 10.6%, in 2008 (p=0.07). Significant discrepancies at autopsies led to changes in institutional healthcare practice in 37.5% of the services. The low number of autopsies was a limiting factor in undergraduate education for 25% of respondents. A minimum number of autopsies is required to complete the pathology residency program in 34.6% of the services. Conclusion: The total number and the rate of academic autopsies have decreased in Brazil between 2003 and 2008. The number of autopsies and the general organization of academic services must be enhanced to improve medical education, research, and the quality control of patient care. .

Objetivo: Investigar o número e a taxa de autópsias acadêmicas, organização geral, ensino e pesquisa em serviços acadêmicos brasileiros. Métodos: Questionários padronizados enviados para escolas médicas brasileiras (n=177) e programas de residência em patologia ativos (n=53) de março a junho de 2009. Dados coletados referentes ao período de 2003 a 2008. Resultados: Trinta e dois serviços em 11 estados responderam à pesquisa. Vinte e um (65,6%) realizam menos de cem autópsias de causas naturais e menos de cinquenta autópsias fetais ou pediátricas/ano. Vinte e quatro (75%) realizam menos de cem autópsias de adultos/ano. Muitas instituições (46,9%) relataram queda no número de autópsias em seis anos. A contagem total e a taxa de autópsias em 2008 variaram, respectivamente, de 1 a 632 (mediana=80) e de 0 a 66% (média=10,6%). Foi observada uma redução contínua no total de autópsias em um grupo de 19 instituições (p<0,01). A mediana da taxa de autópsias caiu de 19,3%, em 2003, para 10,6%, em 2008 (p=0,07). Discrepâncias significativas observadas em autópsias levaram a mudanças na prática institucional de saúde em 37,5% dos serviços. O baixo número de autópsias foi limitante no ensino de graduação para 25% dos entrevistados. Um número mínimo de autópsias é necessário para completar o programa de residência em patologia em 34,6% dos serviços. Conclusão: O número total e a taxa de autópsias acadêmicas diminuíram no Brasil entre 2003 e 2008. O número de autópsias e organização geral dos serviços acadêmicos deve ser melhorado para fortalecer a educação médica, pesquisa e controle de qualidade prestado ao paciente. .

Diferentes faces da depressão no suicídio em idosos / Different aspects of depression in suicide among the elderly

O artigo analisa diferentes faces da depressão associadas a suicídio em idosos, a partir de autópsias psicológicas. Utilizou-se um método retrospectivo para o estudo de mortes indeterminadas, a partir de entrevistas e laudos, que analisa circunstâncias psicossociais associadas ao suicídio. O artigo traz uma predominância de gênero, classe social e raça - mulheres, classe média e alta, brancos - e contextualiza de modo inédito a depressão numa população de alto risco de suicídio, pouco estudada no Brasil e no mundo. Buscou-se reconstituir o nível de saúde física e mental, as circunstâncias sociais e os traços biográficos marcantes para compreender a magnitude da depressão no suicídio. A depressão apareceu na quase totalidade dos casos como diagnóstico primário ou secundário, como sintoma associado a outras comorbidades ou como reação a estressores sociais, demandando diferentes condutas e procedimentos terapêuticos. A associação entre depressão e comorbidade múltipla agrava o prognóstico do caso e amplia cumulativamente o risco de suicídio. A depressão acompanhada de ideações suicidas é um fator de risco que justifica medidas preventivas e imediatas. Recomenda-se ampliar as formas de diagnosticar e tratar assertivamente a depressão em idosos.

This article analyzes different aspects of depression association with suicide among the elderly based on psychological autopsies. The retrospective method was used to study indeterminate deaths, based on interviews and reports, which analyze psychosocial circumstances related to suicide. The paper reveals the predominance of gender, social class and race - women, middle and upper class, white - and, in an unprecedented manner, contextualizes depression in a poorly studied population in Brazil and in the world with high risk of suicide. The physical and mental health, social circumstances and predominant biographical characteristics of the suicide victim were reconstructed in order to assess the impact of depression on suicide. Depression was presented in almost all cases, in primary or secondary diagnosis, as the symptom associated with other co-morbidities or as a reaction to social stressors, demanding different therapeutic approaches and procedures. The association between depression and multiple co-morbidity accentuates the case prognosis and cumulatively increases the risk of suicide. Depression followed by suicidal tendencies is a risk factor which justifies immediate preventive measures. Increasing assertive ways to diagnose and treat depression in old age is recommended.

Autópsias psicológicas e psicossociais de idosos que morreram por suicídio no Brasil / Psychological and psychosocial autopsies of the elderly who committed suicide in Brazil

Analisam-se 51 casos de suicídio de idosos em dez municípios brasileiros, visando a conhecer a interação de variáveis associadas ao fenômeno. Uma revisão sobre o tema dá suporte teórico ao estudo. Tendo como base o método da autópsia psicológica, o estudo parte de um roteiro de entrevista semiestruturada, aplicada e analisada por pares de pesquisadores, mediante um mesmo procedimento de coleta, organização e análise dos dados. O conjunto foi reexaminado através de uma meta-análise de enfoque psicossocial e qualitativo sobre dados dos familiares entrevistados, interpretações dos pesquisadores, contextualização socioantropológica e categorias de relevância. Foram estudadas formas de perpetração e letalidade por sexo, faixa etária, perfil socioeconômico; fatores associados; e motivos atribuídos. Analisou-se a interação de fatores precipitantes relevantes. As conclusões apontam convergências entre estudos epidemiológicos e qualitativos. Doenças graves, deficiências e transtornos mentais juntos formam as principais causas, seguidas de depressão, conflitos familiares e conjugais. Recomenda-se atenção à qualidade de vida dos idosos, especialmente dos homens, que constituem o grupo de maior risco para suicídio.

The authors analyze 51 cases of suicide among the elderly from ten Brazilian municipalities. The objective is to understand the interaction of variables associated with suicide among the elderly. A bibliographic review gives theoretical support to this study. Based on psychological autopsy, the study begins with a semi-structured interview format, which was applied and analyzed by peer researchers, using the same procedure for gathering, organizing and analyzing the data. This material was reviewed using a psychosocial and qualitative meta-analysis approach based on family interview data, researchers' interpretations, socio-anthropological contextualization and relevance categories. Ways of committing suicide, reasons for suicide, associated factors, attributed motives and lethality were studied by sex, age and socioeconomic characteristics. The interaction of major precipitant factors was analyzed. The conclusions showed that there are convergences among epidemiological and qualitative studies. Severe illness, disabilities and mental disorders are the major causes, followed by depression and family and marital conflicts. Close attention to the quality of life of the elderly is recommended, especially of men who constitute the main suicide risk group.

Observar, ouvir, compartilhar: trabalho de campo para autópsias psicossociais / Watching, listening and sharing: field work for psychosocial autopsies

O artigo descreve as etapas de realização do trabalho de campo da pesquisa. É possível prevenir a antecipação do fim? Suicídio de Idosos no Brasil e possibilidades de Atuação do Setor de Saúde, realizada em 10 municípios das cinco regiões do país. A amostra composta por 51 autópsias psicossociais abrangeu cinco idosos que faleceram por suicídio em nove municípios e seis em um deles. Oitenta e quatro familiares foram entrevistados. Trabalhou-se com um roteiro denominado autópsia psicossocial e com observação do contexto. Cada entrevista durou 60 minutos em média, e na maioria dos casos, houve mais de um encontro com os familiares. O estudo foi construído por meio de um processo coletivo que abrangeu compartilhamento da revisão bibliográfica, discussão do universo, das amostras, das estratégias de abordagem, dos resultados de campo e das análises empíricas. Este artigo destaca a preparação teórica, conceitual e prática dos pesquisadores; o processo de elaboração dos instrumentos para o trabalho de campo; informações sobre as fontes de dados existentes e sobre as efetivamente acessadas; apresentação de credencial institucional; entrada no contexto das famílias, dificuldades e estratégias para realização do estudo empírico; entrada e saída do campo; e impacto da pesquisa sobre os investigadores.

The article describes the research realization phases of field work in ten municipalities in five regions entitled "Is it possible to prevent the anticipation of the end? Suicide among the elderly in Brazil and the possibilities for action by the Health Sector." The sample comprises 51 psychosocial autopsies of 5 elderly people who committed suicide in 9 locations and 6 in another. 84 family members were interviewed. Semi-structured psychosocial autopsies and contextual observations were used. Each interview lasted 60 minutes on average and in the majority of the cases there was more than one encounter with family members. The study consisted of a collective process that involved bibliographic review, discussion of the samples, approach strategies, field results and empirical analysis. This article highlights the theoretical, conceptual and practical preparation of researchers and production and standardization of instruments; information about existing data sources and those that are actually used; introduction of institutional credentials; assessment of the family context, difficulties and strategies for empirical study; entrance to and exit from the field; and the impact of the research on the investigators.

Performance of cause-specific childhood mortality surveillance by health workers using a short verbal autopsy tool

Background: The routine use of verbal autopsy in health-care delivery settings has been limited.Hence, the performance of neonatal and postneonatal verbal autopsy (VA) tools developed at theComprehensive Rural Health Services Project (CRHSP), Ballabgarh (India), were assessed.Methods: Short VA tools developed by CRHSP were filled by health workers during their routinehouse visits while standard VA tools of the International Network of Field Sites with continuousDemographic Evaluation (INDEPTH) were filled by trained research workers for all 143 under-fivechildren deaths that occurred in 2008. The level of agreement in the cause of death assigned by thetwo VA tools was assessed by kappa and by comparison of the cause-specific mortality fractions.Results: Among 65 neonatal deaths, the cause specific mortality fraction (CSMF) was 43.1% and40% for low birthweight, 15.4% and 26.2% for birth asphyxia, and 7.7% and 10.8% for pneumoniaby INDEPTH and CRHSP VA tools respectively. In 78 deaths among 29-days to <5-year olds, theCSMF was 29.4% and 26.9% for diarrhoea, and 16.6% each for pneumonia using the INDEPTHand CRHSP VA tools respectively. Kappa for most causes of death was more than 0.8, except forbirth asphyxia, which had a kappa of 0.678.Conclusions: Short VA tools have a satisfactory performance in field settings, which can be usedroutinely by health workers for filling the gaps in the cause-of-death information in places wheremedical certification of cause of death is deficient.

Qualidade das informações registradas nas declarações de óbito fetal em São Paulo, SP / Quality of information registered on fetal deaths certificates in São Paulo, Southeastern Brazil / Calidad de las informaciones registradas en las declaraciones de óbito fetal en Sao Paulo, Sureste de Brasil

OBJETIVO: Avaliar a qualidade da informação registrada nas declarações de óbito fetal. MÉTODOS: Estudo documental com 710 óbitos fetais em hospitais de São Paulo, SP, no primeiro semestre de 2008, registrados na base unificada de óbitos da Fundação Sistema Estadual de Análise de Dados e da Secretaria de Estado da Saúde de São Paulo. Foi analisada a completitude das variáveis das declarações de óbito fetal emitidas por hospitais e Serviço de Verificação de Óbitos. Os registros das declarações de óbito de uma amostra de 212 óbitos fetais de hospitais do Sistema Único de Saúde foram comparados com os dados dos prontuários e do registro do Serviço de Verificação de Óbitos. RESULTADOS: Dentre as declarações de óbito, 75 por cento foram emitidas pelo Serviço de Verificação de Óbitos, mais freqüente nos hospitais do Sistema Único de Saúde (78 por cento). A completitude das variáveis das declarações de óbito emitidas pelos hospitais foi mais elevada e foi maior nos hospitais não pertencentes ao Sistema Único de Saúde. Houve maior completitude, concordância e sensibilidade nas declarações de óbito emitidas pelos hospitais. Houve baixa concordância e elevada especificidade para as variáveis relativas às características maternas. Maior registro das variáveis sexo, peso ao nascer e duração da gestação foi observada nas declarações emitidas no Serviço de Verificação de Óbitos. A autópsia não resultou em aprimoramento da indicação das causas de morte: a morte fetal não especificada representou 65,7 por cento e a hipóxia intrauterina, 24,3 por cento, enquanto nas declarações emitidas pelos hospitais foi de 18,1 por cento e 41,7 por cento, respectivamente. CONCLUSÕES: É necessário aprimorar a completitude e a indicação das causas de morte dos óbitos fetais. A elevada proporção de autópsias não melhorou a qualidade da informação e a indicação das causas de morte. A qualidade das informações geradas de autópsias depende do acesso às informações hospitalares.

OBJECTIVE: To evaluate the quality of information registered on fetal death certificates. METHODS: Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public) were compared to medical records and to the records from Coroners Office. RESULTS: Among death certificates, 75 percent were issues by Coroners Office, with a greater frequency in public hospitals (78 percent). Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroners Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7 percent identified as unspecified fetal death as 24.3 percent as intrauterine hypoxia, while death certificates by hospitals reported 18.1 percent as unspecified and 41.7 percent as intrauterine hypoxia. CONCLUSIONS: Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.

OBJETIVO: Evaluar la calidad de la información registrada en las declaraciones de óbito fetal. MÉTODOS: Estudio documental con 710 óbitos fetales en hospitales de Sao Paulo, Sureste de Brasil, en el primer semestre de 2008, registrados en la base unificada de óbitos de la Fundación Sistema Estatal de Análisis de Datos y de la Secretaria de Estado de la Salud de Sao Paulo. Se analizó la completitud de las variables de las declaraciones de óbito fetal emitidas por hospitales y Servicio de Verificación de Óbitos. Los registros de las declaraciones de óbito de una muestra de 212 óbitos fetales de hospitales del Sistema Único de Salud (público) fueron comparados con los dados de los prontuarios y del registro del Servicio de Verificación de Óbitos. RESULTADOS: Entre as declaraciones de óbito, 75 por ciento fueron emitidas por el Servicio de Verificación de Óbitos, más frecuente en los hospitales públicos (78 por ciento). La completitud de las variables de las declaraciones de óbito emitidas por los hospitales fue más elevada y fue mayor en los hospitales no-públicos. Hubo mayor completitud, concordancia y sensibilidad en las declaraciones de óbito emitidas por los hospitales. Hubo baja concordancia y elevada especificidad para las variables relativas a las características maternas. Mayor registro de las variables sexo, peso al nacer y duración de la gestación fue observada en las declaraciones emitidas en el Servicio de Verificación de Óbito. La autopsia no resultó en mejoramiento de la indicación de las causas de muerte: la muerte fetal no especificada representó 65,7 por ciento y la hipoxia intrauterina, 24,3 por ciento, mientras que en las declaraciones emitidas por los hospitales fue de 18,1 por ciento y 41,7 por ciento, respectivamente. CONCLUSIONES: Es necesario mejorar la completitud y la indicación de las causas de muerte de los óbitos fetales. La elevada proporción de autopsias no mejoró la calidad de la información y la indicación de las causas de muerte. La calidad de las informaciones generadas de autopsias depende del acceso a las informaciones hospitalarias.

Lesões fatais em trauma numa grande metrópole Brasileira: um estudo de autópsias / Fatal trauma injuries in a Brazilian big metropolis: a study of autopsies

OBJETIVO: Este estudo tem o objetivo revisar uma série de mortes por trauma em uma grande metrópole. A intenção é identificar as causas evitáveis de morte. MÉTODOS: Foram estudados prospectivamente 500 casos não selecionados e consecutivos de morte associada ao trauma. As variáveis do estudo foram as seguintes: mecanismo do trauma, etiologia, local da morte, a intervenção cirúrgica, imperícia médica, órgãos lesados e prevenção da mortalidade. Os casos foram agrupados, segundo o mecanismo de trauma, em: trauma penetrante, trauma contuso, intoxicação, afogamento, queimadura e asfixia. RESULTADOS: Foram abordados 418 (83,6 por cento) casos do sexo masculino e 82 (16,4 por cento) do sexo feminino (média de idade 39 ± 19,6 anos, variando de três a 91 anos). O trauma penetrante correspondeu a 217 (43 por cento) casos; já o trauma contuso representou 40 por cento dos casos. O mecanismo de trauma mais comum de morte entre o trauma penetrante foi lesão por arma de fogo, representando 41 por cento do total de casos. Dentro do conjunto dos traumas contusos, o mecanismo mais comum foi o de acidentes de transporte, o que representou 22 por cento do total de óbitos. Aconteceram 71 (14 por cento) casos de mortes evitáveis: tromboembolismo em 35 (7 por cento); complicações infecciosas em 25 (5 por cento), imperícia médica em sete (1 por cento) e lesões tratáveis em pacientes não hospitalizados cinco (1 por cento). CONCLUSÃO: Este estudo mostra que a morte traumática, na cidade de São Paulo, está associada à lesões graves e complexas. Prevenção da morte está relacionada ao controle da violência.

OBJECTIVE: This study aims to review a series of deaths by trauma in a large metropolis. The intention is to identify preventable causes of death. METHODS: We prospectively studied 500 unselected and consecutive cases of death associated with trauma. The study variables were: mechanism of injury, etiology, site of injury, surgical intervention, medical malpractice, damaged organs and the prevention of mortality. The cases were grouped according to the mechanism of injury in: penetrating trauma, blunt trauma, poisoning, drowning, burns and suffocation. RESULTS: We examined 418 (83.6 percent) males and 82 (16.4 percent) females (mean age 39 ± 19.6 years, ranging from three to 91 years). Penetrating trauma accounted for 217 (43 percent) cases, while blunt trauma accounted for 40 percent of cases. The most common mechanism of injury in death by penetrating trauma was gunshot, representing 41 percent of cases. Within the set of blunt trauma, the most common mechanism was traffic accident, which represented 22 percent of total deaths. There were 71 (14 percent) cases of preventable deaths: thromboembolism in 35 (7 percent), infectious complications in 25 (5 percent), medical malpractice in seven (1 percent) and treatable lesions in outpatients in five (1 percent). CONCLUSION: This study shows that traumatic death in the city of São Paulo is associated with serious and complex injuries. Prevention of these types of death would be related to the control of violence.

Diagnóstico post-mortem de infarto agudo do miocárdio em pacientes com insuficiência respiratória aguda - análise demográfica, etiológica e histológica pulmonar / Post-mortem diagnosis of acute myocardial infarction in patients with acute respiratory failure - demographic,etiologic and histological pulmonary analysis

Introdução: A insuficiência respiratória aguda (IRA) está presente em 5% dos pacientes com infarto agudo do miocárdio (IAM) e é associada à mortalidade de 20% a 30% nesses pacientes. Não está claro o papel da inflamação relacionada ao edemaagudo de pulmão (EAP) na gênese da IRA pós IAM. Objetivos: Descrever os dados demográficos, etiológicos e os achados histológicos pulmonares em autópsias realizadas entre 1990 e 2008, de pacientes que morreram por IRA, sem diagnóstico in-vivo de IAM. Métodos: Este estudo considerou 4223 autópsias de pacientes que morreram de IRA nos quais só foi definida postmortem sua causa de morte. O diagnóstico de IAM foi feito porautópsia em 218 (4,63%) pacientes, dos quais foram obtidos: idade, sexo e principais doenças associadas. Os achados pulmonares histológicos foram classificados em: dano alveolar difuso (DAD), edema agudo de pulmão (EAP), hemorragia alveolar (HA) e pneumonia intersticial linfo-plasmocitária (PILP). A probabilidade de IAM desenvolver determinado tipo de achado histopatológico pulmonar foi calculada por regressão logística. Resultados: Foram observados 147 homens, e a mediana de idade foi 64 anos. A análise histopatológica pulmonar mostrou, em ordem decrescente: EAP (72,9%), DAD, PILP e HIA. Broncopneumonia bacteriana esteve presente em 11,9%, hipertensão arterial sistêmica em 10,1%, miocardiopatia dilatada em 6,9%, tromboembolismo pulmonar em 6,0%, cardiomiopatia hipertrófica em 4,6%, doença pulmonar obstrutiva crônica em 3,7% e diabetes mellitusem 3,7% dos pacientes. A análise multivariada demonstrou associação significativamente positiva de IAM com EAP e DAD. Conclusões: Pela primeira vez na literatura, demonstramos, pormeio de autópsias, que em pacientes com IRA que evoluem à óbito sem diagnóstico estabelecido, IAM esteve presente em aproximadamente 5% dos casos. Nós observamos importantecomponente inflamatório na histologia pulmonar, nunca antes sugerido...

Introduction: Acute respiratory failure (ARF) is present in 5% of the patients with acute myocardial infarction (AMI) and is responsible for 20% to 30% of the mortality post-AMI. It is unclearthe role of inflammation correlated with pulmonary edema (PE) as a cause of ARF post-AMI. Objectives: Describe the demographic, etiologic data and histological pulmonary findings in autopsies of patients dead due to ARF with non-diagnosis AMI during lifebetween 1,990 and 2,008. Methods: This study considers 4,223 autopsies of patients who died of ARF without cause of death related during life. The diagnosis of AMI was performed in 218(4.63%) patients, and were obtained: age, sex and major associated diseases. Pulmonary histopathology was categorized as: diffuse alveolar damage (DAD); pulmonary edema (PE); alveolarhemorrhage (AH);and lympho-plamacytic interstitial pneumonia(LPIP). Odds ratio of AMI developing specific histopathology was determined by logistic regression. Results: Were observed 147 men and mean age was 64 years. Pulmonary histopathology showed, in descending order: PE (72.9%), DAD, LPIP and HA. Bacterialbronchopneumonia was present in 11.9%, systemic arterial hypertension in 10.1%, dilated cardiomyopathy in 6.9%, pulmonary embolism in 6.0%, hypertrophic cardiomyopathy in 4.6%, chronic obstructive pulmonary disease in 3.7% and diabetes mellitus in 3.7% of patients. Multivariate analysis demonstrated significantly positive association of IAM with PE and with DAD. Conclusions: For the first time we demonstrated that in autopsies of patients with ARF as cause of death, the diagnosis of AMI was present in about 5%. We observed important inflammatory response in pulmonaryhistology as never suggested before...

Demographic, etiological, and histological pulmonary analysis of patients with acute respiratory failure: a study of 19 years of autopsies

INTRODUCTION: Acute respiratory failure has been one of the most important causes of death in intensive care units, and certain aspects of its pulmonary pathology are currently unknown. OBJECTIVES: The objective was to describe the demographic data, etiology, and pulmonary histopathological findings of different diseases in the autopsies of patients with acute respiratory failure. METHOD: Autopsies of 4,710 patients with acute respiratory failure from 1990 to 2008 were reviewed, and the following data were obtained: age, sex, and major associated diseases. The pulmonary histopathology was categorized as diffuse alveolar damage, pulmonary edema, alveolar hemorrhage, and lymphoplasmacytic interstitial pneumonia. The odds ratio of the concordance between the major associated diseases and specific autopsy findings was calculated using logistic regression. RESULTS: Bacterial bronchopneumonia was present in 33.9 percent of the cases and cancer in 28.1 percent. The pulmonary histopathology showed diffuse alveolar damage in 40.7 percent (1,917) of the cases. A multivariate analysis showed a significant and powerful association between diffuse alveolar damage and bronchopneumonia, HIV/AIDS, sepsis, and septic shock, between liver cirrhosis and pulmonary embolism, between pulmonary edema and acute myocardial infarction, between dilated cardiomyopathy and cancer, between alveolar hemorrhage and bronchopneumonia and pulmonary embolism, and between lymphoplasmacytic interstitial pneumonia and HIV/ AIDS and liver cirrhosis. CONCLUSIONS: Bronchopneumonia was the most common diagnosis in these cases. The most prevalent pulmonary histopathological pattern was diffuse alveolar damage, which was associated with different inflammatory conditions. Further studies are necessary to elucidate the complete pathophysiological mechanisms involved with each disease and the development of acute respiratory failure.