Essentials of Autopsy Practice (eBook)

Preface 5
Contents 7
Contributors 9
Postmortem Toxicological Redistribution 10
Introduction 10
Drug Absorption and Distribution 11
What is Redistribution? 12
Tissue Diffusion 13
Contamination from the Gastrointestinal Tract 13
Movement from Another Site 14
Animal Studies 15
Specific Drug Examples 16
Antidepressants 18
Antipsychotic Drugs 20
Benzodiazepines 20
Cocaine 20
Gamma-hydroxybutyrate (GHB) 20
Ketamine 21
Morphine and Other Opiates 21
MDMA and Other Amphetamines 22
THC 22
Lipid Solubility and Volume of Distribution 22
Other Artefacts Associated with Redistribution 23
Other Tissues 24
Adipose Tissue 24
Muscle 24
Liver 24
Redistribution of Endogenous Substances 24
Case Studies 25
Summary 26
References 26
Examination of Fractures at Autopsy 32
Introduction 32
Is It a Fracture? 33
Example 34
What Age Is the Fracture? 35
Perimortem Fractures 35
12 Hours to 3 Days 35
3-7 Days 36
7-14 Days 37
14-21 Days 39
3-6 Weeks 39
6-12 Weeks 41
Comparing Radiological with Pathological Features of Fracture Healing 43
Examples 44
Fractures in Infancy 44
Rib Fractures in Infancy 44
Birth Injury 44
Resuscitation 45
Non-accidental Rib Fractures 45
Skull Fractures in Infancy 45
Upper Metaphyseal Tibial and Lower Metaphyseal Femoral Fractures in Infants 46
Wrist and Elbow Damage 47
Shoulder Fractures 48
Pathology That May Cause or Contribute to a Fracture 48
Inherited and Congenital Diseases 48
Metabolic Bone Disease and Endocrine Disturbances 49
Localised Bone Disease 51
Summary 51
References 52
The Relationship of Body Weight and Sudden Death 54
Introduction 54
Anorexia Nervosa and Bulimia Nervosa 54
Obesity 56
Obesity and Hypoventilation Syndrome 57
Management of Morbid Obesity and Sudden Death 59
References 60
Fatal Sexual Abuse in Childhood 62
Introduction 62
Definition 64
Prevalance 64
Scene Examination 64
Clothing 66
Autopsy Assessment 66
Problems 67
Decomposition 67
Artefacts 67
Colposcopy 70
Photography 71
Samples 71
Extragenital Injuries 71
General Injuries 71
More Specific Injuries 73
Anogenital Injuries 73
Other 77
Special Dissections 78
Pelvic Exenteration 78
Venereal Diseases 78
Differential Diagnosis 78
Anogenital Injury Not due to Sexual Abuse 79
Skin Conditions 80
Vulvovaginitis 80
Foreign Bodies 80
Tumours 81
Endometrial Bleeding 81
Congenital Anatomical Variants 81
Urethral Prolapse 82
Summary 82
References 83
Elder Abuse and Gerontocide 86
Introduction 86
Crimes Against the Elderly 87
Violence and Public Crime 87
Maltreatment by Caregivers 88
Forms of Maltreatment: Elder Abuse Definition 89
Physical Abuse 91
Blunt Force Trauma 91
Strangulation, Suffocation 97
Burns and Scalds 100
Physical Neglect 103
Starvation and Dehydration 104
Medico-legal Aspects of Pressure Sores 105
Mechanical Restraints 106
Sedatives 108
Suicide Amongst the Elderly 108
Sexual Abuse 110
Killing of the Elderly (Gerontocide, Genocide) 112
Assisted Suicide, Active Euthanasia and Serial Killings 115
Non-physical Abuse and Neglect 116
Differential Presentations Mimics of Elder Abuse
Summary: A Sensitive Approach Without Taboos 117
References 118
Air Crash Investigation for Histopathologists 122
Introduction 122
The Legal Framework 122
The Role of the Pathologist 123
The Crash Site 124
Identification 125
Radiology 126
The Approach to the Autopsy 126
Patterns of Injury 127
Head Injury 128
Spinal Injuries 129
Thoracic Injuries 129
Abdominal and Pelvic Injuries 130
Injuries to the Limbs 131
Control Injuries 132
Injury Scoring 133
Causes of Death Other Than Multiple Injuries 134
Fire 134
Drowning 136
Natural Disease 136
Toxicology 138
Suicide 140
Summary 140
References 141
Bioterrorism 144
Introduction 144
The Bioterrorism Potential: The Anthrax Scenario 146
The Means and Cost of Terrorism 148
The Motives for Bioterrorism 148
The Potential Agents for Bioterrorism 149
Availability, Weaponisation and Dissemination of the Proposed Agents 150
Aerosol Dispersion 152
Basic Definitions in BT Terminology and the Public Health Organisations’ Responses 152
Mortuary Plans and Provisions 154
The Disease That May Present as Bioterrorism 155
Smallpox 155
Clinical Features 156
Differential Diagnosis of Smallpox 156
Treatment 157
Vaccination 157
Diagnostic Procedures and the Autopsy 158
The Pathology of Smallpox (6) 159
The Impact of Smallpox 159
The Impact in the Mortuary 159
Deliberate Release? 161
Anthrax 161
Clinical Presentation 161
Deliberate Release? 163
Plague 163
Tularaemia 163
Viral Haemorrhagic Fevers 165
Botulinum Toxin 166
Surveillance for Bioterrorism 167
Needs and Standards of Autopsy Practice 167
Forensic Epidemiology 168
UK Medico-legal Systems and Bioterrorism 169
Personal Protection for Pathologists and APTs During Autopsy in BT Cases 169
Generic Protocol for the Autopsy and Specimen Collection in Suspected Bioterrorism Cases (14) 170
Disposal of the Cadaver 172
Pathological Identification of BT Agents 172
Summary 174
References 174
The Chronological Dating of Injury 176
Introduction 176
Collection of the Samples and Processing of the Tissue 177
Reporting of the Estimated Time of an Injury 177
Determination of the Estimated Time of Injury 178
Adhesion Molecules 183
Inflammatory Mediators and Extracellular Matrix Components 183
Inflammatory Cells 188
Summary 188
References 188
Index 192