Carl von Rokitansky, el Linneo de la anatomía patológica / Carl von Rokitansky, the Linné of pathological anatomy

Resumen Carl von Rokitansky fue una de las figuras más importantes en la anatomía patológica y el responsable, en parte, del renacimiento de Viena como centro de la medicina a mediados del siglo XIX. Nació en la actual Hradec Králové, estudió medicina en Praga y Viena y se graduó en 1828. Tuvo gran influencia de los estudios de anatomía, embriología y patología de Andral, Lobstein y Meckel. En la escuela de Viena fue asistente de anatomía patológica de Johann Wagner y se convirtió en profesor de anatomía patológica, donde permaneció hasta cuatro años antes de su muerte. Rokitansky hizo énfasis en correlacionar la sintomatología del enfermo con los cambios post mortem. Es posible que haya tenido acceso a entre 1500 y 1800 cadáveres al año para que pudiera realizar 30 000 necropsias; además, revisó varios miles más de autopsias. En Handbuch der Pathologischen Anatomie, publicado entre 1842 y 1846, realizó numerosas descripciones: de la neumonía lobular y lobular, endocarditis, enfermedades de las arterias, quistes en varias vísceras, diversas neoplasias y de la atrofia aguda amarilla del hígado. Con su brillante labor de patología macroscópica, Rokitansky estableció la clasificación nosológica de las enfermedades, por lo cual Virchow lo llamó “el Linneo de la anatomía patológica”.

Abstract Carl von Rokitansky was one of the most important figures in pathological anatomy, and was largely responsible for the resurgence of Vienna as the great medical center of the world in the mid-19th century. He was born in current Hradec Králové, studied medicine in Prague and Vienna and was graduated in 1828. He was greatly influenced by the anatomy, embryology and pathology studies of Andral, Lobstein and Meckel. At the Vienna School, he was Johann Wagner pathological anatomy assistant and became a pathology professor, where he remained until four years before his death. Rokitansky emphasized the importance of correlating patient symptoms with postmortem changes. It is possible that he had access to between 1,500 and 1,800 cadavers annually to be able to perform 30,000 necropsies; in addition, he reviewed several thousand more autopsies. In Handbuch der pathologischen Anatomie, published between 1842 and 1846, he made numerous descriptions: lobar and lobular pneumonia, endocarditis, diseases of the arteries, cysts in several viscera, various neoplasms and acute yellow atrophy of the liver. With his brilliant work on gross pathology, Rokitansky established the nosological classification of diseases, for which Virchow named him “the Linné of pathological anatomy”.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears / Avaliação endoscópica das variações anatômicas da orelha média em uma série de autópsias: análise de 204 orelhas

Abstract Introduction Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. Objective The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. Methods All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. Results One hundred and two cadavers were included in the study. The mean age was 49.08 ± 17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. Conclusion The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Resumo Introdução A otomicrocirurgia requer avaliação completa da anatomia cirúrgica da orelha média, especialmente da anatomia da cavidade timpânica posterior. A avaliação pré-operatória da cavidade timpânica é limitada pela permeabilidade do tímpano e densidade do osso temporal. Portanto, a exploração da orelha média é um método extremamente útil para identificar anormalidades estruturais e variações anatômicas. Objetivo Determinar as variações anatômicas da orelha média em uma série de autópsias. Método Todas as avaliações foram realizadas no necrotério do Instituto Médico-Legal. Os casos com mais de 18 anos, sem trauma do osso temporal e história de cirurgia otológica foram incluídos neste estudo. Resultados Cento e dois cadáveres foram incluídos no estudo. A média de idade foi de 49,08 ± 17,76 anos. A proeminência da parede anterior do conduto auditivo externo estava presente em 27 de todos os cadáveres (26,4%). A membrana timpânica era normal em 192 orelhas (94%), enquanto várias alterações do tímpano foram detectadas em 12 orelhas (6%). Agenesia da eminência piramidal e do tendão do estapédio foi encontrada em 3 orelhas. Enquanto o pontículo tinha formato de crista óssea em 156 das 204 orelhas (76,4%), tinha o formato de ponte em 25 orelhas (12,3%). O pontículo estava ausente em 23 orelhas (11,3%). Enquanto o subículo completo estava presente em 136 de todas as orelhas (66,7%), encontrava-se incompleto em 21 orelhas (10,3%). O subículo estava ausente em 47 orelhas (23%). Deiscência facial foi encontrada em 32 orelhas e o nicho da janela redonda estava coberto por uma pseudomembrana em 85 orelhas (41,6%). A platina fixa foi observada em 7,4% de todas as orelhas e a artéria estapediana persistente não foi vista. Conclusão A frequência da pseudomembrana que cobre o nicho da janela redonda foi diferente daquela encontrada na literatura. Além disso, a frequência da proeminência da parede do canal auditivo externo foi relatada pela primeira vez.

Autopsias realizadas por el Dr. Salvador Allende en el Hospital Carlos van Buren de Valparaíso, Chile / Autopsies performed by Dr. Salvador Allende at Carlos van Buren Hospital of Valparaíso, Chile

Introducción: entre los años 1933 y 1937, el Dr. Salvador Allende trabajó con regularidad en el servicio de Anatomía Patológica del Hospital Carlos van Buren de Valparaíso (HCVB), realizando autopsias en los casos de muertes de causa médica. Materiales y método: se revisaron los libros del servicio de Anatomía Patológica del HCVB del año 1937 y se seleccionaron las autopsias realizadas por el Dr. Allende. Los libros y autopsias de los años 1933 a 1936 no pudieron ser encontrados. Los datos demográficos de los pacientes se traspasaron a una planilla Excel. Los resultados se expresaron en números y porcentajes. Resultados: el Dr. Allende realizó 54 autopsias durante un periodo de 5 meses, lo que correspondió al 12,6% de las realizadas ese año. De los 54 pacientes, 48 (88,8%) correspondieron al sexo masculino, con un promedio de edad de 46 (9-97) años. La mayoría tenían nacionalidad chilena y estaban cesantes. El 53,7% de los casos falleció por una causa infecciosa y las más frecuentes fueron la neumonía y la tuberculosis. La concordancia entre los diagnósticos clínicos y de Anatomía Patológica fue de un 70,3%. Conclusiones: se encontró solo una parte de las autopsias realizadas por el Dr. Allende en el HCVB. La mayoría de los pacientes fallecidos fueron jóvenes del sexo masculino y cesantes. Las principales causas de muerte fueron la neumonía y la tuberculosis. (AU)

Introduction: Dr. Salvador Allende often worked between the years 1933 and 1937 for the pathology department in the Carlos van Buren Hospital, performing autopsies in the medical cause death cases. Materials and Methods: the pathology department books from 1937 were reviewed searching for the autopsies performed by Dr. Allende and those were selected. The books and autopsies of the years 1933-1936 could not be found. The demographic data about patients were transfered into an excel spreadsheet. The results were expressed as numbers and percentages. Results: Dr. Allende performed 54 autopsies over a period of 5 months, which corresponded to 12.6% of all the autopsies performed that year. Of the 54 patients, 48 were male (88.8%), with an average age of 46 (9-97) years. Most of them had Chilean nationality and unemployed. 53.7% of studied cases died by an infectious cause being the most common pneumonia and tuberculosis. The concordance between clinical diagnoses and pathology department were 70.3%. Conclusions: Only a small part of the autopsies performed by Dr. Salvador Allende in HCVB was found. Most deceased patients were young men and unemployed. The main causes of death were pneumonia and tuberculosis.(AU)

Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

OBJECTIVES: An objective of clinical autopsies is to determine the final cause of death and the pathological changes that may have triggered it. Despite advances in Medicine, the level of discrepancy between clinical and autopsy diagnoses remains significant. The aim of this study was to compare the data obtained from autopsies carried out at the São Bernardo do Campo/SP Death Verification Section with clinical diagnostic hypotheses proposed during medical care. METHOD: This was a retrospective study involving the comparison of necroscopic reports issued by the São Bernardo do Campo/São Paulo Death Verification Section in 2014 and 2015 and the Cadaver Referral Guides completed by attending physicians prior to the necroscopic examination. RESULTS: A total of 465 cases were analyzed. In general, discrepancies between the clinical diagnostic hypothesis and the autopsy diagnosis occurred in 28% of the cases. A logistic regression model, with diagnostic discrepancy as a response variable and sex, age, duration of care, type of institution providing medical care and organ system as explanatory variables, was fit to the data; the results indicated that all explanatory variables with the exception of organ system are not significant (p>0.132). CONCLUSIONS: Discrepancies between clinical diagnostic hypotheses and autopsy diagnoses continue to occur, despite new developments in complementary examinations and therapies. The odds of a discrepancy when patients present with diseases of the cardiac system are greater than those when there are problems in the vascular, endocrine and neurological systems.

Improving the usefulness of mortality data: reclassification of ill-defined causes based on medical records and home interviews in Brazil / Aprimorando dados de mortalidade: reclassificação de causas mal definidas baseada em registros clínicos/entrevistas domiciliares no Brasil

ABSTRACT Introduction: Brazil presented a high proportion of ill-defined causes of death (IDCD) in 2000, compromising accurate cause-of-death analysis. Objective: To analyze specific underlying causes for deaths originally assigned as IDCD in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade), after investigation activities implemented in country between 2006 and 2017. Method: For all IDCD identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Specific causes among reclassified IDCD after investigation were evaluated according to age groups and four calendar periods. Results: Proportions of IDCD reassigned to other causes after review increased over time, reaching 30.1% in 2017. From a total of 257,367 IDCD reclassified in 2006-2017, neonatal-related conditions, injury, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively. Discussion: The similarity and plausibility of cause-specific proportions derived from the reclassification of IDCD by age group over time indicate the accuracy of the investigation data. Conclusion: High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.

RESUMO Introdução: As proporções de causas de morte mal definidas (CMD) foram elevadas no Brasil em 2000. Objetivo: Analisar causas específicas para óbitos originalmente como CMD no Sistema de Informação sobre Mortalidade (SIM), após investigação implementada no país entre 2006 e 2017. Metodologia: Para as CMD identificadas no SIM, profissionais das secretarias de saúde coletaram informações sobre a doença final obtida nos registros hospitalares, autópsias, formulários de equipes de saúde da família e investigação domiciliar. Causas específicas entre as CMD reclassificadas após investigação foram avaliadas segundo idade em quatro períodos. Resultados: Proporções de CMD reclassificadas para outras causas após revisão aumentaram ao longo do tempo, atingindo 30,1% em 2017. De um total de 257.367 CMD reclassificadas entre 2006 e 2017, causas perinatais, causas externas, cardiopatia isquêmica e doença cerebrovascular foram os principais grupamentos de causas nos grupos etários de 0-9 anos, 10-29 anos, 30-69 anos, 70 anos ou mais, respectivamente. Discussão: A similaridade e a plausibilidade das proporções de causas específicas detectadas entre as CMD nos grupos etários ao longo do tempo indicam acurácia dos dados da investigação. Conclusão: Causas mais informativas detectadas após a revisão das CMD indicam o sucesso dessa abordagem para corrigir erros de classificação no SIM, que deve ser mantida. Maior capacitação dos médicos no preenchimento do atestado de óbito e melhor acesso e qualificação dos serviços de saúde são importantes para melhoria futura.

Prevalencia de enfermedades infecciosas crónicas en autopsias clínicas / Prevalence of chronic infectious diseases in clinical autopsies

Las enfermedades infecciosas crónicas constituyen un problema de salud pública mundial al ser importante causa de mortalidad. En Guatemala no existen estudios postmortem recientes que aborden dicho tema, por lo que se desconoce su prevalencia en autopsias clínicas del país. El presente estudio se delimita las siguientes enfermedades: tuberculosis, candidiasis, neurocisticercosis, aspergilosis, coccidioidomicosis e histoplasmosis. Objetivo: determinar la prevalencia de las enfermedades infecciosas crónicas en autopsias clínicas. Material y Métodos: investigación descriptiva retrospectiva, basada en los datos de 909 boletas de protocolos completos de autopsias clínicas realizadas del año 2006 al 2015 en el Departamento de patología en el Hospital General San Juan de Dios de Guatemala

Frequency of brain tissue donation for research after suicide

Objectives: To describe the frequency of brain tissue donation for research purposes by families of individuals that committed suicide. Methods: All requests for brain tissue donation to a brain biorepository made to the families of individuals aged 18-60 years who had committed suicide between March 2014 and February 2016 were included. Cases presenting with brain damage due to acute trauma were excluded. Results: Fifty-six cases of suicide were reported. Of these, 24 fulfilled the exclusion criteria, and 11 others were excluded because no next of kin was found to provide informed consent. Of the 21 remaining cases, brain tissue donation was authorized in nine (tissue fragments in seven and the entire organ in two). Conclusions: Donation of brain tissue from suicide cases for research purposes is feasible. The acceptance rate of 42.8% in our sample is in accordance with international data on such donations, and similar to rates reported for neurodegenerative diseases.

Caracterización del acto suicida en el servicio médico legal de Concepción, Chile entre 2011-2015 / Characterization of the suicide act according to the autopsy reports released by the legal medical service of Concepción, Chile 2011-2015

INTRODUCCIÓN: El suicidio se define como el acto donde la propia persona se quita la vida intencionalmente. Actualmente es una problemática mundial y en aumento. El objetivo es caracterizar el acto suicida según los reportes de autopsias realizados por el Servicio Médico Legal (SML) Concepción, durante el periodo 2011-2015. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, descriptivo y trasversal de los informes de autopsia con causa suicidio realizadas por el SML Concepción, periodo 2011-2015 utilizándose las variables: genero, edad, procedencia, lugar de ocurrencia, estado civil, ocupación, patologías asociadas, causa de muerte, alcoholemia, examen toxicológico, llegada al centro asistencial, intentos previos y carta de aviso. Los datos se analizaron y tabularon mediante Microsoft Excel. El trabajo fue aprobado por comité de ética. RESULTADOS: Del total de autopsias 511 fueron suicidios, 83,3% eran hombres, edad promedio 44,8 años, 49,9% casados, 83,6% correspondían a la provincia de Concepción, 75% ocurrió en su domicilio, 88,8% causado por asfixia por ahorcamiento, 57,3% poseían alcoholemia negativa y 67,7% examen toxicológico negativo y solo un 5,1% llego a un centro asistencial. DISCUSIÓN: Las variables más prevalentes de nuestro estudio fueron edad de 20-29 años, género masculino, estado civil soltero y ocupación en empleo técnico. El método y lugar más frecuentes fueron el ahorcamiento y el domicilio respectivamente. Se observa una prevalencia mayor de intoxicación alcohólica que en cifras internacionales. La sustancia más prevalente en los análisis toxicológicos fue la cocaína. Se necesita ampliar la investigación en nuestro medio analizando factores de riesgo y diseñando nuevas estrategias de prevención

INTRODUCTION: Suicide can be defined as the act where the person finish their life intentionally. It is currently an increasing worldwide problematic. The objective is to characterize the suicide act according to the autopsies reports performed by the Legal Medical Service (SML) Concepción, during the period 2011-2015 MATERIAL AND METHOD: We released a retrospective, descriptive and transversal study with the autopsies reports performed by the SML Concepción described as suicide, between 2011­2015. We used variables such as: gender, age, procedence, place of ocurrence, marital state, occupation, comorbidities, death cause, blood alcohol concentration, toxicological results, arrival at a care center, previus attempts and warning letter. Data was analized and tabulated using Microsoft Excel. The study was previusly approved by an ethic committee. RESULTS: From the total autopsies released, 12.6% were suicides (511), from which 83.3% were men, 49.9% were married, 83.6% were from Concepcion, 75% of the suicides occurred at home, 88.8% were asphyxiation by hanging, 57.3% had a negative result of alcohol in blood and 67.7% had a negative toxicological test, 5.1% arrived at a care center. DISCUSSION: The most prevalent variables of our study were age 20-29, male gender, single marital status and occupation in technical employment. The most frequent method and place were hanging and domicile respectively. We observed a higher prevalence of alcohol intoxication than international studies. The most prevalent substance in the toxicological analyzes was cocaine. It is necessary to expand the research in our environment by analyzing risk factors and designing new prevention strategies.

Caracterización del acto homicida según los informes de autopsias realizados por el servicio médico legal de Concepción, periodo 2011-2015 / Characterization of the homicidal act according to the autopsy reports released by the Legal Medical Service of Concepción, 2011-2015

Introducción: Más de la tercera parte de los homicidios reportados a nivel mundial tienen lugar en el continente Americano, siendo Chile uno de los países con las tasas más bajas de Latinoamérica. Actualmente, son escasos los estudios que caracterizan el acto homicida en nuestro país. Se caracterizó el acto homicida según las autopsias realizadas por el Servicio Médico Legal (SML) de Concepción, durante el periodo 2011-2015. Materiales y método: Se realizó un estudio transversal de informes de autopsia con causa homicidio durante los años 2011 a 2015, realizadas por el SML de Concepción, utilizándose las variables: género, edad, procedencia, lugar de ocurrencia del homicidio, estado civil, ocupación, patologías asociadas, causa de muerte, tipo de arma utilizada, alcoholemia, examen toxicológico y atención en centro asistencial. El estudio fue aprobado por comité de ética. Resultados: Del total de autopsias en el periodo 2011-2015; 5.92% (241) correspondieron a homicidios, de los cuales un 89.6% fueron víctimas de sexo masculino. Del total de homicidios estudiados la edad promedio fue de 33 años, un 58.3% del total ocurrieron en vía pública y 42.1% fallecieron por trauma torácico complicado. Finalmente del total de homicidios, un 49,2% poseían alcoholemia negativa y 49.2% examen toxicológico negativo. Discusión: En Chile, el homicidio afecta a una pequeña porción de la población, acercándose a las bajas tasas que presentan diversos países de Europa. En su mayoría, los homicidios reportados fueron hombres entre los 18 y 29 años de edad, resultado similar a lo descrito a nivel mundial.

Introduction: More than a third part of the worldwide reported homicides takes place in the whole american continent, and Chile is one the countries with the lowest rates in latin america. Only a few are the studies that characterize the homicidal act in our country. Characterize the homicide act according to the autopsies reports performed by the Legal Medical Service (SML) of Concepción, during the period 2011-2015. Materials and methods: We made a transversal study with the autopsies reports classified as homicide, performed by the SML Concepción, between the years 2011 and 2015 using variables such as: gender, age, place of residence, place of homicidal act, marital state, occupation, comorbidities, death cause, weapon, blood alcohol concentration, toxicological results and medical assistance. An ethic committee approved the study. Results: From the total autopsies between 2011 and 2015; 5.92% (241) were homicides, of which 89.4% were men. The average age of homicides victims was 33 years old, 58.3% occurred on public areas and 42.1% were died because a complicated thoracic traumatism. And finally from the total homicides, 49.2% had none alcohol in blood such as the 49.2% as well had negative toxicological test. Discussion: In Chile, homicide affects a few number of its population, approaching the low rates that some european countries have. The most of the homicides reported were men between 18 to 29 years old, similar results comparing with the worldwide statistics.

Muertes por suicidio en la Región de Tarapacá, años 1990-2013 / Suicides death in the Region of Tarapacá, years 1990-2013

Introduction: It presents the update of an epidemiologic descriptive study of deaths by suicide that took place in the Tarapacá region, Chile. The study encompasses almost a quarter of a century, between the years 1990 and 2013, and brings interesting information with respect to the tendencies of the phenomenon along an extensive period of time. Method: A retrospective epidemiologic descriptive study of type transvensal of deaths classified as violent in the autopsy protocols of the Servicio Médico Legal of the city of Iquique and the medical death certificate. Results: In a total of 565 cases, a general rate of suicide for this period of 9,18 for 100.000 hab has been noted, with variations of the annual rates between 4, 95 in the year 1995 and 13, 97 in the year 1999. It was observed that suicide was more frequent between the ages 20 and 44 years, with a relation men-women of 5,3:1. Conclusions: The previous study (2010) confirmes a tendency to the stabilization of the increasing rates observed in the past decade. In figures this rate was somehow inferior to the general rate of suicide of the country in the year 2011 (13,3 for 100.00 hab.), but it doubled the registered rates in the 90’s.

Introducción: Se presenta la actualización de un estudio epidemiológico descriptivo de las muertes por suicidio ocurridas en la región de Tarapacá, Chile, abarcando casi un cuarto de siglo, entre los años 1990 y 2013, lo que aporta una interesante información respecto del movimiento tendencial del fenómeno a lo largo de un período extenso de tiempo. Método: Estudio epidemiológico descriptivo de tipo retrospectivo transversal a partir de las muertes clasificadas como violentas en los protocolos de autopsias del Servicio Médico Legal de Iquique y del certificado médico de defunción. Resultados: En un total de 565 casos, constatamos una tasa general de suicidio para el período de 9,18 por 100.000 hab., con variaciones de tasas anuales que van entre 4,95 el año 1995 y 13,97 el año 1999; se observó que el suicidio fue más frecuente entre los 20 y los 44 años, con una relación hombre-mujer de 5,3:1. Conclusiones: Respecto del estudio anterior (2010) se confirma una tendencia a la estabilización del alza de tasas observada en la década anterior, en cifras algo inferiores a la tasa general de suicidio del país en el año 2011 (13,3 por 100.000 hab.), pero el doble respecto a las tasas registradas en los años noventa.

Discrepancias entre el diagnóstico Clínico y Anatomo-Patológico en el Hospital Escuela Universitario De Honduras / Discrepancies between the Clinical and Anatomy-Pathological diagnosis at the Hospital Escuela Universitario in Honduras

La calidad diagnóstica es el resultado de integrar el conocimiento médico y reconocimiento de los errores clínicos, se alcanza únicamente con la identificación de las causas de muerte; es la correlación clínico patológica la herramienta principal para dicha acción. El objetivo general de la investigación fue determinar la discrepancia clínico-patológica y su relación con otras variables en las autopsias realizadas en la institución. Se revisaron 159 protocolos de autopsia del período comprendido entre enero 2012 y junio 2016, elaborados por el Servicio de Patología del Hospital Escuela Universitario de Tegucigalpa, Honduras. Se excluyeron 36 por no cumplir los criterios de inclusión. Se utilizaron la CIE-10 y la clasificación de Goldman et al. para clasificar las patologías y establecer las discrepancias diagnósticas, respectivamente. El sexo predominante fue el femenino (2,96:1), la edad media fue de 38 años; prevalecieron los diagnósticos de embarazo/parto/puerperio y enfermedades infecciosas y parasitarias. Concluimos que en 46% de los casos existe discrepancia diagnóstica y la glomerulonefritis fue la principal causa de error, seguida de bronconeumonía. Se recomienda estandarizar el protocolo de autopsias y promover sesiones clínico-patológicas periódicas e integrales.

Diagnostic quality is the result of the integration of medical knowledge and recognition of clinical error, achieved only by identifying the cause of death; clinical pathological correlation is the primary tool for this action. The overall objective of this research was to determine clinical pathological discrepancy and its relationship with other variables within the autopsies performed at the institution. 159 autopsy protocols, elaborated by the Department of Pathology of Hospital Escuela Universitario in Tegucigalpa, Honduras, from January 2012 to June 2016, were reviewed. 36 were excluded for not meeting the inclusion criteria. ICD-10 and Goldman et al. modified by Battle criteria were used to classify diseases and establish diagnostic discrepancies, respectively. The majority of patients were female (2.96:1), the mean age was 38 years old; diagnoses of pregnancy/birth/puerperium and infectious and parasitic diseases prevailed. We conclude that diagnostic discrepancies exist in 46% of all cases and glomerulonephritis was the leading cause of error, followed by bronchopneumonia. It is recommended that autopsy protocols be standardized, and integrative clinical pathological sessions are promoted and integral.

Aplicación del sistema aterométrico en fallecidos por muerte violenta con aterosclerosis coronaria / Application of atherosclerosis indexing system in deceased subjects by violent death with coronary aterosclerosis

INTRODUCCIÓN: la alta morbimortalidad de causa aterosclerótica ha motivado múltiples investigaciones y en Cuba, el Sistema Aterométrico, permite caracterizar las lesiones ateroscleróticas en cualquier sector vascular. OBJETIVO: estudiar la aterosclerosis de los tres vasos coronarios principales en fallecidos por muerte violenta y clínica, analizando comparativamente las lesiones, teniendo en cuenta sexo y grupo de nivel aterosclerótico. MÉTODOS: se aplicó el Sistema Aterométrico para estudiar comparativamente coronaria derecha y coronaria izquierda en sus ramas descendente anterior y circunfleja, en una población de 108 fallecidos por muerte violenta y 472 por muerte clínica, agrupados también según nivel aterosclerótico y sexo. RESULTADOS: la mayor diferencia se encontró en las placas fibrosas del grupo de alto nivel aterosclerótico para la coronaria derecha, que llegó a ser de un 22,3 % mayor en los clínicos, siendo solamente del 17,5 % para la descendente anterior y de 20,3 % en la circunfleja. En este mismo grupo las placas fibrosas fueron 2,59 veces más frecuentes en la descendente anterior que en la coronaria derecha. Las placas fibrosas entre los sexos tuvieron poca diferencia, en ambos grupos, solamente alrededor de 1 % para los tres vasos coronarios. CONCLUSIONES: es mayor la aterosclerosis en los fallecidos por muerte clínica que en los fallecidos por muerte violenta, tanto en la población en su totalidad, como subdividida en los grupos de alto y bajo nivel aterosclerótico así como en hombres y mujeres, resultando el Sistema Aterométrico muy útil en la evaluación del proceso aterosclerótico en fallecidos por muerte violenta.

INTRODUCTION: the high morbidity and mortality of atherosclerotic causes has motivated multiple investigations and in Cuba, the atherometric system to characterize atherosclerotic lesions in any vascular sector. OBJECTIVE: Study atherosclerosis of the three main coronary vessels in violent deaths from clinical death and comparatively analyzing the injury, considering sex and level of atherosclerosis. METHODS: Atherometric system was used to comparatively study right and left coronary artery in their anterior descending coronary artery branches and circumflex, in a population of 108 violently dead subjects and 472 clinical dead subjects, also grouped according to atherosclerotic level and sex. RESULTS: The main difference was found in fibrous plaques of the atherosclerotic high level group for the right coronary, which reached 22.3% higher in clinical, and only 17.5% for the descending left anterior and 20.3% in the circumflex. In this same group, fibrous plaques were 2.59 times more frequent in the anterior descending coronary right. Fibrous plaques according to genders had little difference in both groups, only about 1% for the three coronary vessels. CONCLUSIONS: the atherosclerosis is higher clinical dead subjects than violently dead subjects, as much in the overall population, as subdivided in the groups of high and low atherosclerotic level, as in men and women, proving to be the very useful Atherometric System for assessing the atherosclerotic process in violently dead subjects.

Medición de la circunferencia abdominal en autopsias / Measurement of the abdominal circumferences in autopsies

OBJETIVO: evaluar la relación de la medida de la circunferencia abdominal con la edad y sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, especialmente las relacionadas con el síndrome metabólico. MÉTODOS: se procesaron por el Sistema Automatizado de Registro y Control de Anatomía Patológica, entre 2008 y 2011, 420 autopsias en las que se midió la circunferencia abdominal a nivel del ombligo. Se crearon tres grupos de estudio según la circunferencia, con un número similar de casos: 54-81,2 cm, 82,3-96,5 cm y 97-161 cm. RESULTADOS: en el grupo de mayor circunferencia disminuyó el promedio de edad y fue de más de 65 años; el 60,4 % correspondió al sexo masculino y el 67,1 % al femenino. Entre las causas de muerte aumentó la bronconeumonía, de 20,1 % a 10,1 %, el cáncer, la falla/daño múltiple de órgano y, en especial, el infarto agudo del miocardio; y disminuyó la enfermedad cerebrovascular. Como causas contribuyentes se encontraron la elevación de la hipertensión arterial y la diabetes mellitus. En los trastornos relacionados con el síndrome metabólico, los órganos más afectados fueron las arterias, el páncreas, el hígado, el corazón y la vesícula biliar. CONCLUSIONES: la medición de la circunferencia abdominal en las autopsias resulta un indicador apropiado para precisar la obesidad, así como su relación con la edad y sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, principalmente aquellas que forman parte del síndrome metabólico.

OBJECTIVE: to evaluate the association of the abdominal circumference index with age and sex, hospital parameters, causes of death and other diagnosed diseases, mainly those related to the metabolic syndrome. METHODS: the Automated System of Registration and Control of Pathological Anatomy processed 420 autopsies from 2008 through 2011, in which the abdominal circumference was measured at the navel. Three circumference-dependent study groups with similar number of cases were created: 54-81.2 cm; 82.3-96.5 cm and 97-161 cm. RESULTS: in the group with the biggest circumference value, the average age decreased, being over 65 years old; 60.4 % were men and 67.1 % were women. Among the causes of death, the incidence of bronchial pneumonia, cancer, multiple organ failure/damage and especially acute myocardial infarction rose whereas that of cerebrovascular diseases decreased. Increased blood hypertension and diabetes mellitus were found to be contributing factors. As to the metabolic syndrome-related disorders, the most affected organs were arteries, pancreas, liver, heart and gallbladder. CONCLUSIONS: measurement of the abdominal circumference in autopsies is an adequate indicator to determine obesity and its association with age, sex, hospital parameters, causes of death and other diagnosed diseases, mainly those that are part of the metabolic syndrome.

Autopsias realizadas en el Hospital "Comandante Manuel Fajardo Rivero" / Autopsies performed at "Comandante Manuel Fajardo Rivero" Hospital

OBJETIVO: realizar un análisis multicausal de la muerte a partir de las autopsias realizadas en el Hospital "Comandante Manuel Fajardo Rivero". MÉTODOS: estudio retrospectivo, longitudinal en 2 480 autopsias de la base de datos de autopsias del SARCAP, realizadas en el Hospital Militar "Comandante Manuel Fajardo Rivero" entre 1991 y 2011. Se analizaron las variables: sexo, edad, especialidades de egreso, estadía hospitalaria, principales enfermedades, causas de muerte y evaluación de sus diagnósticos premortem. RESULTADOS: predominó el sexo masculino (51,7 %) y el grupo etario de 75-84 años (31 %). El 79,6 % de los pacientes fallecidos fueron en el área de atención al grave y el 47,8 % de los casos fallecieron con hasta 48 h de estadía. Las principales causas directas de muerte fueron la bronconeumonía y el infarto cardiaco; mientras las básicas fueron la aterosclerosis coronaria, cerebral y generalizada. Y entre las principales causas contribuyentes estuvieron la hipertensión arterial y la diabetes mellitus. Las discrepancias para las causas directas y básicas de muerte se presentaron en una de cada cuatro autopsias. CONCLUSIONES: el estudio multicausal de la muerte permite caracterizar los principales problemas de salud. La aplicación del SARCAP y el diagnóstico del daño multiorgánico han sido logros importantes de la especialidad alcanzados en la institución. La metodología de trabajo para el estudio de la autopsia y su empleo en la mejora continua de la calidad de la asistencia médica en este centro constituye referencia para otros hospitales.

OBJECTIVE: to conduct a multi-causal analysis of death on autopsies performed at "Comandante Manuel Fajardo Rivero" Hospital. METHODS: a retrospective, longitudinal study was conducted in 2480 autopsies from SARCAP autopsy database, at "Comandante Manuel Fajardo Rivero" Military Hospital from 1991 to 2011. Variables were analyzed including sex, age, hospital stay, major diseases, and causes of death and assessment of their pre-mortem diagnosis. RESULTS: there was 51.7 % predominance of males and 31 % of the 75-84 year- age group. 79.6 % of the patients who died were in the assistance area of severe patients and 47.8 % of patients who died were up to 48 hours in hospital. The main direct causes of death were bronchopneumonia and cardiac infarction; while widespread coronary and cerebral atherosclerosis was the basic infections. High blood pressure and diabetes mellitus were among the major contributing causes. Discrepancies for direct and underlying causes of death occurred in one of every four autopsies. CONCLUSIONS: the multi-causal study of death allows characterizing main health problems. SARCAP application and diagnosis of multiple organ failure has been important achievements in the specialty at this institution. The methodology for autopsy study and its use in the continuous improvement of the quality of medical care at this facility is a milestone to other hospitals.