Handbook of Autopsy Practice PDF
Preview Handbook of Autopsy Practice
Handbook ofAutopsy Practice Handbook of Autopsy Practice Fourth Edition Brenda L. Waters, MD Department ofPathologyand LaboratoryMedicine, University ofVermont and FletcherAllen Health Care, Burlington, VT, USA ~ Springer Editor BrendaL. Waters,MD AssociateProfessor DepartmentofPathologyandLaboratoryMedicine UniversityofVermont and FletcherAllenHealthCare Burlington,VT,USA ISBN:978-1-58829-841-6 e-ISBN:978-1-59745-127-7 DOl: 10.1007/978-1-59745-127-7 LibraryofCongressControlNumber:2008928069 ©HumanaPress2009,apartofSpringerScience+BusinessMedia,LLC Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewrittenpermissionofthepublisher(HumanaPress,999Riverview Drive,Suite208.Totowa,NJ07512USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Useinconnectionwithanyformofinforma tionstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyarenotidentifiedassuch,isnottobetakenasanexpression ofopinionastowhetherornottheyaresubjecttoproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoingtopress,neithertheauthorsnortheeditorsnorthepublisher canacceptanylegalresponsibilityforanyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty.expressorimplied,withrespecttothematerial containedherein. Printedonacid-freepaper springer.com Dedication Idedicatethisbookto NicholasJ. Hardin, teacher, mentor, colleague, andfriend, who instilled in meandmany others, anunwaveringquestfor excellencein autopsy pathology. v Preface Inthetwenty-fiveyearsofmypracticeIhaveseensignificantchanges,manyofwhichtestifytothecontinuedevolutionofautopsy pathology.Technologicadvancementssuchascomputerizedlabinformationsystems,moleculardiagnostics,immunohistochemi calmethods,digitalimagingand the Internethavehadimportantapplications to autopsy pathology. Aless welcomedchangeis the decline inthe autopsy rate in teaching hospitals- adecline that threatens to continue. Onereason for this may bethe more sophisticatedimaging techniques which some believe supplantthe needfor postmortem exam. Another may bethe discomfort that house staffand attendings still experience when asking for permission. Nevertheless, the autopsy remains the diagnostic gold standard. Recent medical literature is rich with articles extolling the diagnostic power ofthe postmortem exam. Beyond the autopsy's critical role in transmitting information to clinicians, the postmortem examination procedure provides unrivaled opportunitiesforpathologyresidents tohone theessential skills oftheirtrade. Theseskillsincludeefficientandsafedissection techniques,appropriatehandlingofunexpectedfindings,meticulouswrittenandphotographicdocumentation,accurateinterpreta tionoffindings, andfinally,timely,compassionate, andprofessionalcommunicationwithfamilies, physiciansandlegalcounsel. This writer's view is thatthe future ofautopsy pathology is founded on the perpetuationofthese skills. Itis with this vision in mindthatthe4theditionoftheHandbookisoffered. PartIofthe4theditionhassixcompletelynewchaptersinwhichthereaderwillfind anassortmentoftoolsthatwillincrease the valueofthe autopsy. There is a sample next-of-kin letter which is sent to the family member who authorized the autopsy, following distributionofthe final report. Thisletternotifiesthe personthatthereportiscompleteandinviteshim/hertodiscuss the autopsy findings with the involved physician. The reader will find aquality assurance worksheet thatcan be used to check foromissions,discrepanciesorinsufficientlysupportedconclusionsin thefinalreport. Anew discourseonthedissectionproce dure is accompaniedby aworksheetandtemplatefor the grossdescription. Thereis also a new, detaileddiscussion ofthesafe handlingofsharps,completewithphotographs. Thesamesuperbphotographs,characteristicofWilliamEdwards, highlightthe chapterdevotedtothecardiovascularsystem.ThereaderwillfindtheupdatedrequirementsoftheEyeBankofAmericaandthe U.S. Food and Drug Administration for oculartissue transplantation. Significant advancements incytogenetic techniques have occurred since the 3rdedition, especially with respect to the application ofmolecular methods using fluorescent labeled DNA probes.Theupdatedcytogeneticschapterwillhelpautopsypathologiststodecipherwhenconventionalchromosomestudiesare usefulandwhenmolecularcytogeneticmethodsaremoreapplicable. Added to the discussion oflegal aspects ofautopsy practice is material on common law and statute law pertaining to dead bodiesandautopsies ingeneral.Manyquestionsthatoftenarise, suchas whocanview an autopsy, whocanreceivetheautopsy reportandhow organsortissuesare donatedfor transplantation, areaddressed. Althoughavirtualgrossspecimenmuseumcanbecreatedusingdigitalimages,teachingwithactualpathologicspecimensmay stillhavearoleineducatingmedicalstudentsandininspiringelementaryandsecondaryschoolstudents.Therefore,theapplied science oflong-term organ preservation is discussed with many ofthe venerable fixatives from the previous editions retained. New items are a step-by-step procedure for paraffin-embedding hearts (courtesy ofthe Cardiac Registry at Boston Children's Hospital)andaconcisedescriptionofthefascinating techniqueofplastination. PartIIhasbeenupdatedwithnewdiseasesandrecentreferencesadded.Practicingautopsypathologists,residentsandstudents areinvitedtoreview this alphabeticallistingofdisorders beforeeachautopsyinordertore-acquaintthemselves with whatthey mightencounter. PartIIIconcludesthebookwith aseries oftables providingorgan weights andbody measurements forfetuses, childrenand adults.Manyofthesearemorerecentthanthoseofthe3rdedition.Thegrowthchartsforchildrenarepresentedinalargerformat tofacilitate theiruse. vii VIII PREFACE Iwishtothankallthecontributorsto this book, pastandpresent,whohelpedtomaintainautopsypathology as animportant and evolving field. Iam indebtedto CandaceLaFreniereforhersecretarialhelpand to Raj Chawlaforhis expertphotographic skills. Iwishalso tothankmylongtimecolleague,fellow autopsy pathologistandfriend, Dr. Nicholas1. Hardin, who reviewed manyofthe newchaptersand offeredmuchhelpful advice. Hiseditorial skillsareexceededonly by his skillsas apathologist. Histhoroughinvestigativeapproachtoeverypostmortemexamthankfullyrubbedoffon me. Tohim, Idedicatethisbook. BrendaL Waters, MD Contents Preface........ vii Contributors xi PART I AUTOPSYTECHNIQUES AND PROCEDURES . 1 EnsuringQualityintheHospitalAutopsy.. 3 BrendaL Waters 2 PrinciplesofDissection 11 BrendaL Waters 3 CardiovascularSystem................................................................................................................................................... 27 WilliamD. EdwardsandDylan V. Miller 4 NervousSystem 51 CaterinaGianniniandHamo Okazaki 5 EyeandAdnexa. 69 R.leanCampbellandCherylR. Hann 6 AutopsyLaboratory 77 BrendaL Waters 7 AutopsyMicrobiology........................................... 85 BrendaL Waters 8 AutopsyChemistry 89 Vernard1.Adams 9 ChromosomeAnalysisofAutopsyTissue..................................................................................................................... 93 Gordon If.Dewald 10 PostmortemImagingTechniques.. 99 lurgenLudwig 11 AutopsiesofBodiesContainingRadioactiveMaterials 105 Kelly L. Classic ix x CONTENTS 12 TheHospitalAutopsy Report,DeathCertification 111 BrendaL Waters 13 MedicolegalAutopsyandPostmortemToxicology.,..................................................................................................... 125 VernardI. Adams 14 LegalAspectsofAutopsyPractice.. 137 VernardI. Adams 15 FixationandTransportofAutopsyMaterial.................................................................................................................. 145 BrendaL Waters 16 MuseumTechniques 151 BrendaL Waters PART II ALPHABETIC LISTINGOF DISEASES AND CONDITIONS 157 Jurgen Ludwigwith VernardI.Adams(MedicolegalCasesandToxicologicDisorders) WilliamD. Edwards(CardiovascularDisorders) CaterinaGiannini(NeuropathologicDisorders) BrendaL Waters (PediatricandInfectiousDisorders) PARTIII NORMALWEIGHTSAND MEASUREMENTS 541 Hagen Blaszyk, WilliamD. Edwards, Jurgen Ludwig,andBrendaL Waters Index 575 Contributors VERNARDI.ADAMS, MD • MedicalExaminerDepartment, Hillsborough County, DepartmentofPathologyandLaboratory Medicine, UniversityofSouth Florida, Tampa, FL, USA HAGENBLASZYK,MD • DepartmentofPathology, MaineMedical Center, Portland, ME, USA R.JEAN CAMPBELL, MD • EmeritusMember, DepartmentofLaboratoryMedicineandPathology, andofOphthalmology, Mayo Clinic, andEmeritusProfessorofPathology, CollegeofMedicine, Mayo Clinic, Rochester, MN, USA KELLYL. CLASSIC,MS • SectionofSafety, Mayo Clinic, Rochester, MN, USA GoRDONW.DEWALD,PHD • EmeritusMember,DepartmentofLaboratoryMedicineandPathology,MayoClinic, Emeritus ProfessorofLaboratoryMedicineandPathology,andMedicalGenetics, CollegeofMedicine,MayoClinic, Rochester,MN, USA WILLIAMD. EDWARDS, MD • DivisionofAnatomicPathology, Mayo Clinic, ProfessorofLaboratoryMedicine andPathology, CollegeofMedicine, Mayo Clinic, Rochester, MN, USA CATERINAGIANNINI. MD • DivisionofAnatomicPathology, Mayo Clinic, AssociateProfessorofLaboratoryMedicine and Pathology, CollegeofMedicine, Mayo Clinic, Rochester, MN, USA CHERYLR. HANN,MS • OphthalmicPathologyAssistant, OphthalmologyResearchLaboratories, Mayo Clinic, andInstructor inLaboratoryMedicineandPathology, CollegeofMedicine, Mayo Clinic, Rochester, Minnesota, USA JURGENLUDWIG,MD • EmeritusMember, DepartmentofLaboratoryMedicineandPathology, MayoClinic, Rochester,MN, USA DYLANV. MILLER,MD • DivisionofAnatomicPathology, Mayo Clinic, AssistantProfessorofLaboratoryMedicine andPathology, CollegeofMedicine, Mayo Clinic, Rochester, MN, USA HARUOOKAZAKI,MD • EmeritusMember, DepartmentofLaboratoryMedicine andPathology, Mayo Clinic, Rochester, Minnesota; EmeritusProfessorofLaboratoryMedicine, CollegeofMedicine, Mayo Clinic, USA BRENDAL.WATERS,MD • AssociateProfessorofPathologyandLaboratoryMedicine, UniversityofVermontandFletcherAllen Health Care, Burlington, VT, USA xi
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