Declining autopsy rates in stillbirths and infant deaths: results from Funen County, Denmark, 1986-96.

OBJECTIVE: The aim of this study was to describe the development of the autopsy rate in stillbirths and infant deaths in an 11-year period and evaluate the information gained by performing an autopsy. METHODS: Included in the study were all stillbirths and infant deaths in Funen County, Denmark, in 1986-96. Data sources were death certificates and autopsy reports. RESULTS: The study included 273 stillbirths and 351 deaths in infancy. The rates of stillbirth and infant death did not change significantly during the period. The overall autopsy rate for stillbirths was 70% and for infant deaths 57%. There was a significant decline in autopsy rate during the years 1991-96 as compared with 1986-90 for stillbirths, infant deaths and infant deaths excluding sudden infant death syndrome. In stillbirth, the autopsy changed the diagnosis in 9% of the cases. In 22%, the clinical diagnosis was maintained, but additional information was obtained. In infant death, the numbers were 10% and 40%, respectively. CONCLUSION: In 10% of the autopsies the diagnosis was changed completely, with an impact on genetic counseling as well as on statistical records of causes of death in fetuses and infants. With additional information in 22-40% of the autopsies, the study emphasizes autopsy as a useful investigation.

Organ weights in healthy and apparently healthy Danish infants.

The weights of brain, heart, liver, kidneys, spleen, lungs, and thymus were registered in 222 forensic autopsies of Danish infants aged 1 week to 0.99 year (137 males, 85 females), who prior to death were healthy or apparently healthy based on clinical evidence. Variability of organ weights was estimated, and the relationship between individual organ weights and age, body weight, and body length, and the sum of organ weights was evaluated in relation to age, body weight, and body length. No significant differences were found between males and females, and between the healthy and apparently healthy infants. There was a positive, significant correlation of the individual organ weights with age, body weight, and body length. It was most pronounced for the weight of the brain and least pronounced for the thymus. Am. J. Hum. Biol. 9:35-38 © 1997 Wiley-Liss, Inc.

Armanni-Ebstein lesions of the kidney: diagnostic of death in diabetic coma?

In the period from January 1986 through April 1993, 47 cases with diabetes mellitus were autopsied at the Institute of Forensic Medicine, Odense University. In 26 cases, the diabetes had been treated with insulin, in 21 cases with oral medication or diet only. In eight insulin-dependent cases, tubular vacuolation was found in the kidneys, the so-called Armanni-Ebstein lesions. The circumstances of death and postmortem analyses of blood, urine and/or vitreous humor supported a presumed diabetic coma as the cause of death in these eight cases. Of the remaining 39 cases, six were too putrefied for histologic examination. In the remaining 33 cases and in a series of 20 non-diabetics, the cause of death was ascertained as illness (other than diabetes), traffic accidents, drowning or intoxication. In none of these cases was a diabetic coma suspected, and none of these cases showed tubular vacuolation in the kidneys. The authors conclude that tubular vacuolation of the kidneys strongly indicates death in diabetic coma.

[Safety in using metal tracheostomy tubes]. / Sikkerheden ved brug af metaltrakealkanyler.

The breakage of a stainless steel tracheostomy tube resulted in the death of a 19-year old man. Technical investigations identified corrosion as the mechanism of degradation of the braced joint between the plate and the external tube. Examination of a stock of 112 sterling silver tubes showed corrosive attacks on four tubes. Recommendations are presented concerning the production, maintenance and control of metal tracheostomy tubes.

Renal myoglobin in drug addicts: occurrence and significance in a postmortem study.

In a 3-year period (1989-1991) a non-selected, consecutive series of 62 deaths in drug addicts was autopsied at the Forensic Institute in Odense. The kidney sections from these addicts were examined for the presence of renal myoglobin using immunohistochemical methods. A reference group consisting of a non-selected, non-consecutive series of 58 autopsied non-addicts was likewise investigated for the presence of renal myoglobin. No major differences were demonstrated between the two groups. The presence of renal myoglobin probably indicates a prolonged course of events prior to death (unconsciousness, immobilization, hypovolemia). In sufficient amounts, renal myoglobin may be of importance as a cause of death or a contributing factor to death in both drug addicts and non-addicts.

[Lobar pneumonia in alcoholics]. / Lobaer pneumoni hos alkoholikere.

Four cases of unexpected death in chronic alcoholics are described where autopsy showed lobar pneumonia. Attention is drawn to the problems related to recognising this disease in this patient category, where the symptoms may be incompletely described or atypical and contact to a doctor frequently occurs late in the course of the disease.

Weights of brain, heart, liver, kidneys, and spleen in healthy and apparently healthy adult Danish subjects.

Based on a forensic material of 1,598 autopsies of Danish adults (1,086 males, 512 females ≥ 16 years of age), who prior to death were healthy or apparently healthy based on clinical evidence, the weights of brain, heart, liver, kidneys, and spleen were registered. The variability of organ weights was estimated. Relationships between organ weights and body size, and among organ weights were also evaluated. Males had larger organ weights than females. When organ weights were based on the same estimated fat free mass, interesting differences between the sexes were observed: weights of the heart and brain were smaller in females, but weights of the kidney were the same; weights of the liver were consistently larger in females than in males. Useful comparisons of the data with previous studies were impossible because of differences in the criteria of health and of insufficient numbers. © 1993 Wiley-Liss, Inc.

Periappendicitis and diagnostic consequences.

A ten year series of 2660 appendicectomies revealed the microscopic diagnosis to be periappendicitis in 50 cases (1, 9%). In 7 cases the appendicectomy was incidental. Of the remaining 43 patients 21 had salpingitis, 15 had other intraperitoneal inflammation, and in 7 cases no obvious explanation could be found. Peroperatively, periappendicitis was suspected in 3 of the 43 cases, in 18 patients the appendix was judged to be normal and in 17 inflamed. It is important to be aware of the existence of periappendicitis as it often produces signs of intraperitoneal inflammation.

A polypoid duodenal somatostatinoma. A case report.

A case of a pedunculated, polypoid duodenal somatostatinoma is presented. The clinical and pathologic aspects of duodenal somatostatinomas are summarized and briefly discussed.

Prevalence of condylomatous atypia and human papilloma virus antigen in cervical biopsies in 1972 and 1983.

To compare the frequency of pure condylomas and condylomatous atypia in cervical intra-epithelial neoplasia in 1972 and 1983, two equally sized consecutive series of specimens from the uterine cervix were reviewed. The 1972 material contained only 5 cases of pure condyloma, all of these being flat lesions, while the 1983 material contained 33 pure condylomas, 23 flat and 10 papillomatous cases. The prevalence of cervical intra-epithelial neoplasia with condylomatous atypia was significantly greater in the 1983 material. In both years, condylomatous atypia was more frequent in intra-epithelial neoplasia of lower degrees, and patients with intra-epithelial neoplasia with condylomatous atypia were younger than patients with neoplasia only. The proportion of patients with cervical intra-epithelial neoplasia with condylomatous atypia showing positive reaction for HPV-Ag was also larger in the 1983 material. The results are discussed, especially regarding the possible role of HPV infection in cervical carcinogenesis and the increasing rate of invasive carcinoma of the cervix, observed during recent years.

Meningiomas with a non-meningotheliomatous component. A new type of tumour?

Seven cases of meningiomas with "pseudopsammoma bodies" have previously been described in the literature. Two additional cases are presented. Electron microscopy of the cells surrounding the "pseudopsammoma bodies" reveals an ultrastructure different from that of the meningotheliomatous cells. It is concluded that meningotheliomatous meningiomas with "pseudopsammoma bodies" are mixed tumours, including a non-meningotheliomatous component, the origin and significance of which is uncertain.