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An autopsy and Histopathology-based Study to Ascertain the Cause of Death of Brought Dead Cases

Journal of Forensic Science and Medicine 2024年第1期10卷 28-33页

作者： Chandan Bandyopadhyay Prabir Chandra Paul Prabhas Chandra Chakraborty Department of Forensic and State Medicine Medical CollegeKolkataWest BengalIndia Department of Pathology Jagannath Gupta Institute of Medical Science and HospitalKolkataWest BengalIndia Department of Forensic Medicine and Toxicology NRS Medical College and HospitalKolkataand M.G.M Medical College and L S.K HospitalKishanganjBiharIndia

Background and Objectives:The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as“Brought Dead.”These include the cases of sudden death,unexplained death,and unattended death.The cause of such deaths is reported in the literature to emanate principally from the cardiovascular system,though there are some documented geographical,racial,and other variations.In the present study,we endeavored to detect the cause of such natural deaths in terms of the disease and the organ system involved,in the deceased individuals of the contemporary Bengali population,with cases due to obvious unnatural causes being excluded.Materials and Methods:An observational,cross-sectional study with 105(n=105,male:89,female:16)study subjects of age group of 20-80 years,selected by systemic random sampling,from the brought dead subjects coming to the mortuary of the NRS Medical College and Hospital for medicolegal autopsy from April 2011 to March 2012,excluding cases having a history of the obvious unnatural event.Organ system-wise gross examination was done,followed by tissue sampling for histopathological examination.The case-wise findings were tabulated and analyzed for descriptive statistics using SPSS software.Results:In the present study,89 cases were male(84.8%)and 16 cases were female(15.2%),which reflects a male:female ratio of 5.56:1.The dead bodies are mostly recovered from the footpaths(47 cases,44%).Sixty-four(61%)cases are of known identity.In 54 cases out of 105(51.4%),morbid pathology is detected in the respiratory system(RS),lobar pneumonia,and cavitary pulmonary tuberculosis being the most frequent disease entity,in both genders.Fifty-one years-sixty-five years is found to be the most commonly affected age group,in both genders.Interpretation and Conclusions:The present study shows that the most common organ system involved in brought dead cases is the RS,which is supported by a few Indian studies.

关键词： autopsy brought dead cause of death histopathology

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autopsy results from a COVID-19 patient treated in a tropical area,and a review of the epidemiological history

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Forensic Sciences Research 2022年第3期7卷 560-565页

作者： Jie Cai Bo Wang Tao Song Peng Zhang Ren Long Xiaoran Liu Jianqiang Deng Jianhua Chen Department of Forensic Medicine Hainan Tropical Forensic Engineering Research CenterHainan Medical UniversityHaikouChina Key Laboratory of Emergency and Trauma of Ministry of Education Emergency and Trauma CollegeHainan Medical UniversityHaikouChina

Since the start of the COVID-19 pandemic,there has been an urgent need to produce accurate and sensitive tests.However,there have been instances where a positive nucleic acid test turns negative after treatment,and then positive again.This case report describes such an instance from the tropical region of Hainan,China.The patient was a 61-year-old female who went to Hainan on vacation from Wuhan during the COVID-19 pandemic in 2020.Symptoms appeared 9 d after arriving in Hainan,and it was confirmed that the nucleic acid test was positive after 4 repeats.Her condition declined rapidly,her heart stopped beating,and she was admitted in a coma to the ICU.After treatment,the SARS-CoV-2 virus nucleic acid test of several nasopharyngeal swabs were negative,and tests on whole blood,anal swabs,and urine were also negative.Later,however,nucleic acid tests on a lower respiratory tract sputum swab and lower respiratory tract lavage fluid were positive.An autopsy examination was carried out 12h after her death,and multi-organ secretions were extracted for nucleic acid testing.The SARS-CoV-2 virus nucleic acid was only detected in the swabs from the end of the bronchus,which was confirmed by the visualization of the coronavirus by electron microscopy.autopsy confirmed that the damage was mainly concentrated in the lungs and immune organs and tissues throughout the body.Epidemiology indicated that none of the people she came into contact with after arriving in Hainan,including close contacts,were infected.This is in sharp contrast to the highly contagious virus in Wuhan in the temperate zone during the same period.This case report indicates:(1)The high temperatures in tropical areas may have an impact on the spread and harm of COVID-19,and(2)The reason why nucleic acid testing for COVID-19 was initially negative and then positive after treatment may be related to the survival of the SARS-CoV-2 virus in deep lung tissues.

关键词： Forensic sciences forensic pathology COVID-19 SARS-CoV-2 autopsy tropical area epidemiological history

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Liver pathology in COVID-19 related death and leading role of autopsy in the pandemic

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World Journal of Gastroenterology 2023年第1期29卷 200-220页

作者： Martina Zanon Margherita Neri Stefano Pizzolitto Davide Radaelli Monica Concato Michela Peruch Stefano D'Errico Department of Medical Surgical and Health Sciences University of TriesteTrieste 34149Italy Department of Medical Sciences University of FerraraFerrara 44121Italy Department of Pathology Santa Maria della Misericordia University HospitalUdine 33100Italy

BACKGROUND Information on liver involvement in patients with coronavirus disease 2019 is currently fragmented.AIM To highlight the pathological changes found during the autopsy of severe acute respiratory syndrome coronavirus 2 positive patients.METHODS A systematic literature search on PubMed was carried out until June 21,2022.RESULTS A literature review reveals that pre-existing liver disease and elevation of liver enzyme in these patients are not common;liver enzyme elevations tend to be seen in those in critical conditions.Despite the poor expression of viral receptors in the liver,it seems that the virus is able to infect this organ and therefore cause liver damage.Unfortunately,to date,the search for the virus inside the liver is not frequent(16%of the cases)and only a small number show the presence of the virus.In most of the autopsy cases,macroscopic assessment is lacking,while microscopic evaluation of livers has revealed the frequent presence of congestion(42.7%)and steatosis(41.6%).Less frequent is the finding of hepatic inflammation or necrosis(19%)and portal inflammation(18%).The presence of microthrombi,frequently found in the lungs,is infrequent in the liver,with only 12%of cases presenting thrombotic formations within the vascular tree.CONCLUSION To date,the greatest problem in interpreting these modifications remains the association of the damage with the direct action of the virus,rather than with the inflammation or alterations induced by hypoxia and hypovolemia in patients undergoing oxygen therapy and decompensated patients.

关键词： Liver COVID-19 autopsy Immunohistochemistry In situ hybridization Immunofluorescence

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Gastrointestinal tuberculosis:An autopsy-based study

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Infectious Medicine 2023年第2期2卷 122-127页

作者： Julio Cesar Mantilla Juan JoséChaves Ferney Africano-Lopez Néstor Blanco-Barrera Marta Juliana Mantilla Department of Pathology Universidad Industrial de SantanderBucaramanga 680002Colombia Department of Pathology Hospital Universitario de SantanderBucaramanga 680002Colombia Department of Pathology Fundación Universitaria de Ciencias de la SaludBogotá111411Colombia Department of Gastroenterology Gastrocenter and Medical SpecialitiesIpiales 524061Colombia Department of Gastroenterology Universidad Militar Nueva GranadaBogotá250240Colombia Department of Rheumatology Universidad de la SabanaChía 250001Colombia

Background:Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide.Gastrointestinal tuberculosis is an unusual presentation.It is defined as the involvement of any segment of the digestive tract,associated viscera,and peritoneum.The study’s main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia.Methods:This is a retrospective and descriptive study of autopsy reports.A total of 4,500 autopsies were performed between January 2004 and December 2020.The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization.Results:Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study.Most of the patients were male(n=35,72.9%)with a median age of 40.5 years old.Human immunodeficiency virus infection history was reported in 28 cases(58.33%).The most affected gastrointestinal tract site was the terminal ileum.Ulcers and thickened epithelium were common autopsies macroscopic findings.Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis.Conclusions:Gastrointestinal tuberculosis is a disease of great importance,being its diagnosis a clinical challenge.Underdiagnosis can be reported in a high percentage of cases,so autopsy diagnosis can help reveal more accurate data about this condition.

关键词： Gastrointestinal tuberculosis autopsy Forensic pathology Infections Colombia

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Pathological changes in the lungs and lymphatic organs of 12 COVID-19 autopsy cases

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National Science Review 2020年第12期7卷 1868-1878页

作者： Qian Liu Yu Shi Jun Cai Yaqi Duan Rongshuai Wang Hongyan Zhang Qiurong Ruan Jiansha Li Lei Zhao Yifang Ping Rong Chen Liang Ren Xiaochun Fei Heng Zhang Rui Tang Xi Wang Tao Luo Xindong Liu Xuequan Huang Zhenhua Liu Qilin Ao Yong Ren Jing Xiong Zhicheng He Haibo Wu Wenjuan Fu Pengnan Zhao Xinwei Chen Guoqiang Qu Yunyun Wang Xi Wang Jia Liu Dongfang Xiang Sanpeng Xu Xiaowei Zhou Qingrui Li Jinghong Ma Heng Li Jie Zhang Sizhe Huang Xiaohong Yao Yiwu Zhou Chaofu Wang Dingyu Zhang Guoping Wang Liang Liu Xiu-Wu Bian Department of Forensic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Institute of Pathology Southwest HospitalThird Military Medical University (Army Medical University) Key Laboratory of Tumor Immunopathology Ministry of Education of China Department of Pathology Shanghai Jiao Tong University School of Medicine Institute of Pathology Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Department of Pathology Tongji Medical CollegeHuazhong University of Science and Technology

Systematic autopsy and comprehensive pathological analyses of COVID-19 decedents should provide insights into the disease characteristics and facilitate the development of novel therapeutics.In this study,we report the autopsy findings from the lungs and lymphatic organs of 12 COVID-19 decedents—findings that evaluated histopathological changes,immune cell signature and inflammatory factor expression in the lungs,spleen and lymph nodes.Here we show that the major pulmonary alterations included diffuse alveolar damage,interstitial fibrosis and exudative inflammation featured with extensive serous and fibrin exudates,macrophage infiltration and abundant production of inflammatory factors(IL-6,IP-10,TNFαand IL-1β).The spleen and hilar lymph nodes contained lesions with tissue structure disruption and immune cell dysregulation,including lymphopenia and macrophage accumulation.These findings provide pathological evidence that links injuries of the lungs and lymphatic organs with the fatal systematic respiratory and immune malfunction in critically ill COVID-19 patients.

关键词： COVID-19 SARS-CoV-2 autopsy histopathology immune disorder

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Differences in coronary microvascular lesions in coronary heart disease and hypertension:an autopsy study of elderly patients

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Chinese Medical Journal 2004年第2期17卷 207-212页

作者：李小鹰李蕊于雯石怀银韦立新 Department of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China

Background In the case of hypertension, lesions in the microvessels of the target organs precede and deteriorate futher after arteriosclerosis in the small arteries. Thus coronary microvascular lesion (CML) was considered the crucial factor contributing to damage to the target organs. The purpose of this study is to observe the characteristics and differences of CML in autopsies of elderly patients with essential hypertension (EHT), coronary heart disease (CHD), or EHT with CHD, given the same degree of left ventricular wall thickness (LVWT).Methods A retrospective study was performed on 246 cases of patients over 60 years old with EHT, CHD, or EHT with CHD, and on 26 cases without cardiovascular disease as controls , out of a total of 3195 consecutive autopsied cases. The arterioles (with diameter 10 -60 μm) and the capillaries in the cardiac muscle layer were examined by haematoxylin and eosin staining, elastic van Gieson staining, and CD31 immunohistochemistry. To quantify CML severity, measurements were taken of arteriole density (AD), the ratio of wall-to-lumen area of arteriole (RWL), and capillary density (CD), using light microscopy and computer image analysis. Based on LVWT, the cases were divided into four degrees, from Ⅰ to Ⅳ. The EHT, CHD, and EHT with CHD groups all rated LVWT Ⅰ -Ⅳ, and the control group rated LVWT Ⅰ. SAS software was used for statistical analysis.Results With the aggravation of LVWT, both AD and RWL increased while CD decreased significantly in the EHT group (P<0. 05 -0. 0001); there were similar but more severe changes in the EHT with CHD group (P<0. 001 -0. 0001); and AD increased (P <0.001) while RWL and CD did not change significantly in the CHD group.Conclusion Comparing EHT with CHD patients, there are similar patterns of change to AD, but different patterns of change to RWL and CD. CML is much more severe in EHT patients with CHD. We conclude that CML is one of the main causes of decreased coronary flow reserve and myocardial damage in both EHT p

关键词： hypertension coronary heart disease microvascular lesion autopsy

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HISTOPATHOLOGY AND IMMUNOHISTOPATHOLOGY OF LYMPH NODES OF THE FIRST autopsy WITH HIV POSITIVITY IN CHINA

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中华医学杂志(英文版) 1992年第10期105卷 813-817页

作者：来茂德徐英含戴迪汤德骥韩永坚 Department of Pathology Zhejiang Medical University Hangzhou 310006

Nineteen lymph nodes of a HIV-positive boywere studied histologically and immunohistologically.According to Stutte’s classincation of HIV-relatedlymphadenopathy,84% of the lymph nodes were at thethird or fourth stages in relation to clinical statusARC/AIDS.Lymph follicle atrophy,angiogenesis,histiocytic proliferation and destruction of the normalreticulum frame were observed.Immunohistochemicalstudies showed most of the remaining lymphocytes tobe T cells and changes in the distribution of S-100 pos-itive cells.Ki 1 positive cells existed mainly at the sec-ond stage.The significance of these changes is dis-cussed.

关键词： Age Factors Asia autopsy Biology Case Studies Child Child, Male China Demographic Factors Developing Countries Diseases Eastern Asia Examinations And Diagnoses Histology Hiv Infections Laboratory Examinations And Diagnoses Population Population Characteristics Research Methodology Studies Viral Diseases Youth

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Fluctuations in the rate of autopsy in China

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Chinese Medical Journal 2011年第20期124卷 3403-3407页

作者： ZHU Ming-hua YU Dang-hui Department of Pathology Changhai Hospital Second MilitaryMedical University Shanghai 200433 China

autopsy has played a unique role in the progression of clinical medicine, medical education, epidemiology, and public health. However, the autopsy rate has been decreasing during the past several decades worldwide, and its necessity is frequently argued. autopsy-based research in China, a country with the world＇s largest population, is very important for studying the spectrum and epidemiology of diseases as well as for discovering new diseases. This article summarizes the brief history of autopsy in China and analyzes the cause of its decline in recent decades by reviewing previously published papers, review articles, self-collected materials, and private correspondence. Since the first officially permitted autopsy in 1913, China witnessed the highest autopsy rate between 1950 and 1970, and since then the autopsy rate began to decline as it in other parts of the world. The main reasons for the reduction in autopsy rates in China include negligence by hospital administrators and relevant government authorities, unmotivated clinicians, helpless pathologists, unenforceable regulations and laws, and local cultures and customs.

关键词： autopsy health policy pathology

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Diagnostic imaging, preautopsy imaging and autopsy findings of 8 AIDS cases： a comparative study

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Chinese Medical Journal 2009年第18期122卷 2142-2148页

作者： LI Hong-jun GAO Yan-qing CHENG Jing-liang ZHANG Yu-zhong Department of Radiology First Affiliated Hospital of Zhengzhou University Zhengzhou Henan 450052 China Therapeutic Centre for AIDS and Sexually Transmitted Diseases Affiliated You'an Hospital Capital Medical University Beijing 100054 China Center for Diagnostic Medical Imaging Nanfang Hospital Southern Medical University Guangzhou Guangdong 510515 China

Background Aquired immune deficiency syndrome （AIDS） presents a challenge to medical researchers because of its unique pathological and clinical picture. The clinical data, particularly autopsy evidence, from China have failed to provide enough pathological and etiological evidence for AIDS diagnosis, which impairs the reliability of the diagnosis and our full understanding of the occurrence and development of AIDS complications. The purpose of this study was to investigate the imaging and pathologic characteristics of AIDS. Methods autopsy, imaging and pathological data from 8 cases of AIDS were retrospectively analyzed. Routine CT scanning of different body parts was performed during their periods of hospitalization. Transverse CT scanning was conducted from the skull to the pelvis immediately after the occurrence of death. After routine formalin fixing, 7 cardevers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each section and organs for pathological examinations. Results The autopsy data indicated the presence of parasitic infections, bacterial infections, fungal infections, and virus infections in AIDS patients. Pneumocystis pneumonia, pulmonary tuberculosis, coccobacteria pneumonia, Aspergillus pneumonia, cytomegaJovirus pneumonia, toxoplasma encephalitis, lymphoma and cerebrovascular diseases were found in these patients. Conclusions During the course of AIDS progression, the concurrent multiple infections as well as tumor development may resuJt in multiple organ pathological changes and clinically complex symptoms that further complicate the imaging and pathological manifestations, thus resulting in difficult differential diagnosis. A combination of imaging data and autopsy data can help to clarify the diagnosis.

关键词： AIDS pathology diagnostic imaging autopsy

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autopsy Procedure and Standards for Deaths of Unknown Cause during the COVID-19 Pandemic

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Journal of Forensic Science and Medicine 2020年第2期6卷 69-74页

作者： Hongbing Pang Ningbo Institute of Criminal Science and Technology Ningbo Institute of Criminal Science and Technology ResearchNingboZhejiang 315000China

At any time during the current coronavirus disease(COVID-19)pandemic period,forensic pathologists of public security departments in China may come in contact with corpses of unknown or unclear disease history.When these forensic pathologists perform autopsies on corpses with unknown cause of death,they inevitably face a high risk of severe acute respiratory syndrome coronavirus 2019(SARS-CoV-2)infection throughout the autopsy process.In the present paper,the various aspects of the autopsy procedure for corpses with unknown cause of death,including preautopsy preparations,personnel protection,autopsy operations,postautopsy disinfection,and equipment requirements,were explored on the basis of relevant laws and regulations such as the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases,characteristics of the novel coronavirus and COVID-19,guidelines for epidemic prevention and control,the guiding opinions on the regulation of on-site inspection and handling processes during the COVID-19 pandemic period issued by the ministry of public security,and the current practices of public security forensic pathologists.Recommendations for the autopsy procedure and protection measures for public security forensic pathologists during the COVID-19 pandemic period have been proposed to provide a reference for frontline forensic pathologists and judicial authenticators.

关键词： autopsy coronavirus disease 2019 forensic pathologist novel coronavirus procedure standards

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