Clinically latent and autopsy-verified inflammatory disorders and malignant tumours in transplant patients

2020 ◽  
pp. jclinpath-2020-207080
Author(s):  
Elias Mund ◽  
Johannes Salem ◽  
Hans H Kreipe ◽  
Kais Hussein
Keyword(s):  
Respiratory Failure ◽  
Clinical Diagnosis ◽  
Causes Of Death ◽  
Diagnostic Techniques ◽  
Class I ◽  
Malignant Tumours ◽  
Inflammatory Disorders ◽  
Autopsy Findings ◽  
Transplant Patients ◽  
Postmortem Examinations

AimsThe number of clinical autopsies decreases while the rate of missed relevant diagnoses is known to be 2%–20%. In this study, we focused on postmortem examinations of patients after transplantation of solid organs.MethodsA total of 122 cases were assessed for this study. Transplant organs included liver (LiTx; n=42/122, 34%), heart (n=8/122, 7%), lungs (n=32/122, 26%), kidney (KTx; n=38/122, 31%) and KTx+LiTx (n=2/122, 2%).ResultsThe most frequent autopsy-verified causes of death were cardiac or respiratory failure (together n=85/122, 70%). The frequency of malignant tumours that were identified at autopsy was 5% (n=6/122). In 3% (n=4/122) of cases, Goldman class I discrepancies between clinical diagnosis and autopsy findings were identified.ConclusionsThe rate of missed relevant diagnoses might be relatively low, but these cases nevertheless refute the contention that modern diagnostic techniques negate the need for autopsies in patients who died after transplantation.

scholarly journals Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort study

2020 ◽  
Author(s):  
Rob G. H. Driessen ◽  
Bartholomeus G. H. Latten ◽  
Dennis C. J. J. Bergmans ◽  
Riquette P. M. G. Hulsewe ◽  
Johanna W. M. Holtkamp ◽  
...  
Keyword(s):  
Intensive Care ◽  
Clinical Diagnosis ◽  
Causes Of Death ◽  
Early Death ◽  
Class I ◽  
Icu Patients ◽  
Icu Admission ◽  
Clinical Diagnoses ◽  
Important Diagnostic Tool ◽  
Record Review

AbstractEarly death in sepsis occurs frequently; however, specific causes are largely unknown. An autopsy can contribute to ascertain causes of death. The objective of the study was to determine discrepancies in clinical diagnosis and postmortem findings in septic intensive care unit (ICU) patients deceased within 48 h after ICU admission. All septic ICU patients who deceased within 48 h after ICU admission were identified and included. Four intensivists determined the clinical cause of death by medical record review. An autopsy was performed within 24 h of death. Clinical diagnosis and postmortem findings were compared and classified as autopsy-identified missed clinical diagnoses and autopsy-refuted diagnoses. Class I and II missed major diagnoses using the Goldman criteria were scored. Between 2012 and 2017, 1107 septic patients were admitted to ICU. Of these, 344 patients (31%) died, of which 97 patients (28%) deceased within 48 h. In 32 (33%) early deceased patients, an autopsy was agreed. There were 26 autopsy-identified missed clinical diagnoses found, mostly myocardial infarction (n = 4) and pneumonia (n = 4). In four patients (13%), a class I discrepancy was found. In fourteen patients (42%), a class II discrepancy was found. In conclusion, an autopsy is an important diagnostic tool that can identify definite causes of death. These diagnoses deviate from diagnoses established during admission in early deceased sepsis patients.

scholarly journals Discrepancies between clinical and autopsy diagnosis of cause of death among psychiatric patients who died due to natural causes. A retrospective autopsy study

2019 ◽  
Vol 76 (3) ◽  
pp. 278-283
Author(s):  
Dragan Mitrovic ◽  
Ivana Savic ◽  
Radmila Jankovic
Keyword(s):  
Cardiovascular Diseases ◽  
Clinical Diagnosis ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Psychiatric Patients ◽  
Psychiatric Hospitals ◽  
Control Group ◽  
Natural Death ◽  
Autopsy Findings ◽  
Somatic Diseases

Background/Aim. Autopsy studies rarely investigate the causes of natural death in psychiatric population. The aim of this study was to examine the causes of death among the subjects with various psychiatric disorders in whom a clinical (pathoanatomical) autopsy was requested. Methods. The study group included 118 patients (65% men, 35% women, mean age 58.2 ? 13.6 years) with a psychiatric diagnosis, in whom a clinical autopsy was performed. We compared the distribution of causes of natural death among psychiatric patients and other patients, representatives of the general population who died of natural causes. We also analyzed the difference between clinical diagnoses of cause of death and the autopsy findings in psychiatric patients. Results. Psychiatric patients died earlier than the control group (58 vs. 69 years), usually due to the respiratory (46%) and cardiovascular diseases (37%). The most common diagnoses in psychiatric patients were organic psychoses and dementias (F00-F09) and schizophrenia and schizoaffective disorders (F20-F29). Majority of the patients (55%) died in general hospitals vs. specialized psychiatric hospitals (45%) due to somatic diseases. There was a significant difference in the distribution of causes of death compared to the control group in which the cardiovascular diseases dominated. Even in 64% of psychiatric patients there was a discrepancy between the clinical diagnosis of the cause of death and definite autopsy findings. Conclusion. The assessment of somatic diseases in psychiatric patients is insufficient, especially in specialized psychiatric hospitals. That leads to a significant discrepancy between clinical diagnosis of the cause of death and autopsy findings. Therefore, it is necessary to pay additional attention in diagnostics and treatment of somatic diseases in these patients to improve their health care.

Causes of death in beef cattle in southern Brazil

2021 ◽  
pp. 104063872110079
Author(s):  
Franciéli A. Molossi ◽  
Bianca S. de Cecco ◽  
Camila B. Pohl ◽  
Rogério B. Borges ◽  
Luciana Sonne ◽  
...  
Keyword(s):  
Beef Cattle ◽  
Causes Of Death ◽  
Diagnostic Category ◽  
Diagnostic Value ◽  
Parasitic Diseases ◽  
Porto Alegre ◽  
Pathology Laboratory ◽  
Regional Location ◽  
Young Cattle ◽  
Postmortem Examinations

We determined the prevalence of diseases and pathogens associated with mortality in beef cattle in the State of Rio Grande do Sul, Brazil, based on pathology laboratory submissions. Postmortem examinations were conducted on 1,277 beef cattle that died between 2008 and 2018. Information regarding age, time of the year, breed, and regional location were analyzed statistically. Most cattle were from the surrounding region of Porto Alegre, and 78.7% of the analyzed cases had diagnostic value. The diagnostic category with most cases was infectious and/or parasitic diseases (60%), followed by toxic and toxicoinfectious (25%). Most cases occurred in the fall. Major disease conditions identified included hemoprotozoal infection (18.2%), rabies (8.2%), and plant intoxications by Senecio spp. (8.5%) and Pteridium arachnoideum (4.6%). Hemoprotozoal infection occurred at a higher frequency in young cattle, mainly in animals up to 1 y old. Intoxication by Senecio spp. was more frequent in cattle 2–3 y old.

scholarly journals Undetected Causes of Death in Hospitalized Elderly with COVID-19: Lessons from Autopsy

2021 ◽  
Vol 10 (7) ◽  
pp. 1337
Author(s):  
Astrid Malézieux-Picard ◽  
Cecilia Ferrer Soler ◽  
David De Macedo Ferreira ◽  
Emilie Gaud-Luethi ◽  
Christine Serratrice ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Causes Of Death ◽  
Clinical Findings ◽  
Pathological Examination ◽  
Post Mortem ◽  
Hypoxemic Respiratory Failure ◽  
Hospitalized Elderly ◽  
Acute Decompensation ◽  
Clinical Chart ◽  
Full Body

Background: Mechanisms and causes of death in older patients with SARS-CoV-2 infection are still poorly understood. Methods: We conducted in a retrospective monocentric study, a clinical chart review and post-mortem examination of patients aged 75 years and older hospitalized in acute care and positive for SARS-CoV-2. Full body autopsy and correlation with clinical findings and suspected causes of death were done. Results: Autopsies were performed in 12 patients (median age 85 years; median of 4 comorbidities, mainly hypertension and cardiovascular disease). All cases showed exudative or proliferative phases of alveolar damage and/or a pattern of organizing pneumonia. Causes of death were concordant in 6 cases (50%), and undetected diagnoses were found in 6. Five patients died from hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), five had another associated diagnosis and two died from alternative causes. Deaths that occurred in the second week were related to SARS-CoV-2 pneumonia whereas those occurring earlier were related mainly to heart failure and those occurring later to complications. Conclusions: Although COVID-19 hypoxemic respiratory failure was the most common cause of death, post-mortem pathological examination revealed that acute decompensation from chronic comorbidities during the first week of COVID-19 and complications in the third week contributed to mortality.

scholarly journals Systemic congenital lymphangiomatosis

1996 ◽  
Vol 114 (5) ◽  
pp. 1278-1281 ◽  
Author(s):  
Ligia Maria Suppo de Souza ◽  
Maria Regina Bentlin ◽  
Eliana Souto de Abreu ◽  
Carlos Eduardo Bacchi
Keyword(s):  
Young Adults ◽  
Respiratory Failure ◽  
Rare Disease ◽  
Poor Prognosis ◽  
Rare Case ◽  
Soft Tissues ◽  
Lymphatic Channel ◽  
Autopsy Findings ◽  
Children And Young Adults ◽  
Cervical Area

Systemic lymphangiomatosis is a rare disease characterized by the exageration of lymphatic channel proliferation, occurring in children and young adults. We describe an extremely rare case of congenital systemic lymphangiomatosis in a newborn who had ascitis and respiratory failure develop immediately after delivery. Death occurred during the first hour of life. Autopsy findings showed numerous cysts in soft tissues of the cervical area, mediastinum and diaphragm, and several other organs including the liver, spleen, thyroid and kidneys. The severe and diffuse involvement with cysts in both lungs by lymphangiomatosis was associated with poor prognosis and death in our case.

ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS

PEDIATRICS ◽  
1950 ◽  
Vol 5 (2) ◽  
pp. 184-192
Author(s):  
HERBERT C. MILLER
Keyword(s):  
Cause Of Death ◽  
Premature Infants ◽  
Neonatal Death ◽  
Causes Of Death ◽  
Neonatal Period ◽  
Full Term ◽  
Maternal Complications ◽  
Term Infants ◽  
Neonatal Deaths ◽  
Postmortem Examinations

An analysis of the significant causes of death in 4117 consecutive births was made; there were 66 fetal deaths and 85 neonatal deaths. A significant cause of death was determined in 51 fetuses and 56 live-born infants. Eighty-five per cent of the live-born infants who weighed over 1000 gm. at birth and had postmortem examinations had causes of death which were considered to be significant. Almost half of the live-born premature infants with birth weights between 1000 and 2500 gm. were considered to have had more than one significant cause of death. The so-called significant causes of death among live-born infants differed from those determined for fetuses dying before birth. Among the former, pathologic conditions in the infants were determined four times more frequently than in those dying before birth and, in the latter, maternal complications of pregnancy and labor were diagnosed as significant causes of death five times more frequently than in infants dying in the neonatal period. Hyaline-like material in the lung was considered to be the most frequent significant cause of death in live-born premature infants; congenital malformation and anoxia resulting from complications of labor were the most frequently determined significant causes of death in live-born full term infants. No differences were found in the significant causes of death in premature and full term fetuses. Anoxia resulting from accidental and unexpected interruption of the blood flow in the placenta and umbilical cord and from dystocia was the most frequently determined significant cause of death in both groups. A plea has been made for the adoption by obstetricians, pathologists and pediatricians of a formal uniform plan of classifying the causes of fetal and neonatal death which would divest current efforts to determine the cause of death of as much vague terminology and arbitrary opinion as possible.

The Role of the Autopsy in Medical Malpractice Cases, I

2002 ◽  
Vol 126 (9) ◽  
pp. 1023-1031 ◽  
Author(s):  
Kevin E. Bove ◽  
Clare Iery
Keyword(s):  
Clinical Diagnosis ◽  
Medical Malpractice ◽  
Standard Of Care ◽  
State Court ◽  
Medical Negligence ◽  
Trial Court ◽  
Autopsy Findings ◽  
Original Trial ◽  
Autopsy Diagnosis

Abstract Context.—Fear that damaging information from autopsy may be introduced as evidence in lawsuits alleging medical malpractice is often cited as one factor contributing to the decline in autopsy rates. Objective.—To determine how autopsy information influences the outcome of medical malpractice litigation. Design.—We studied state court records in 99 cases of medical malpractice adjudicated from 1970 to the present to assess the role of information from autopsies in the outcomes. Results.—The 3 largest groups defined by cause of death at autopsy were acute pulmonary embolism, acute cardiovascular disease, and drug overdose/interaction. Findings for defendant physicians outnumbered medical negligence in the original trial proceedings by a 3:1 margin. The appellate courts affirmed 51 acquittals and 19 findings of negligence, and reversed the original trial court decision in 29 cases for technical reasons. We found no significant relationship between accuracy of clinical diagnosis (using the autopsy standard) and outcome of a suit charging medical negligence. Even when a major discrepancy existed between the autopsy diagnosis and the clinical diagnosis, and the unrecognized condition was deemed treatable, defendant physicians were usually exonerated. Moreover, major diagnostic discrepancies were relatively uncommon in suits in which a physician was found to be negligent. Conversely, in about 20% of cases, autopsy findings were helpful to defendant physicians. Conclusions.—Our study confirms that a finding of medical negligence is based on standard-of-care issues rather than accuracy of clinical diagnosis. Autopsy findings may appear to be neutral or favorable to either the plaintiff or the defendant, but are typically not the crux of a successful legal argument for either side in a malpractice action. We conclude that fear of autopsy findings has no rational basis and is an important obstacle to uninhibited outcomes analysis.

scholarly journals Agreement between premortem and postmortem diagnoses in patients with acquired immunodeficiency syndrome observed at a brazilian teaching hospital

1997 ◽  
Vol 39 (4) ◽  
pp. 217-222 ◽  
Author(s):  
Aércio Sebastião BORGES ◽  
Marcelo Simão FERREIRA ◽  
Sérgio de Andrade NISHIOKA ◽  
Marco Túlio Alvarenga SILVESTRE ◽  
Arnaldo Moreira SILVA ◽  
...  
Keyword(s):  
Acquired Immunodeficiency Syndrome ◽  
Causes Of Death ◽  
Single Case ◽  
Postmortem Examination ◽  
Multiple Infections ◽  
Postmortem Diagnosis ◽  
Clinical Diagnoses ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Postmortem Examinations

Acquired immunodeficiency syndrome (AIDS) is one of the main causes of death in adults worldwide. More commonly than in the general population, in patients with AIDS there is substantial disagreement between causes of death which are clinically suspected and those established by postmortem examination. The findings of 52 postmortem examinations were compared to the premortem (clinical) diagnoses, and there was 46% agreement between them. Fifty two percent of the patients had more than one postmortem diagnosis, and 48% had at least one AIDS-related disease not suspected clinically. Cytomegalovirus infection was the commonest (30.7%) autopsy finding, but not a single case had been suspected premortem. Bacterial infection, tuberculosis, and histoplasmosis were also common, sometimes not previously suspected, postmortem findings. This study shows that multiple infections occur simultaneously in AIDS patients, and that many among them are never suspected before the postmortem examination. These findings suggest that an aggressive investigation of infections and cancers should be done in patients with AIDS, particularly in those who do not respond to therapy of an already recognized condition

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