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Diagnostics
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Autopsy for Medical Diagnostics 2.0
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Autopsy for Medical Diagnostics 2.0

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 8383

Special Issue Editors

Dr. Giulia Ottaviani

E-Mail Website
Guest Editor
Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
Interests: anatomic pathology; cardiovascular pathology; autopsy for medical diagnostics; pathology of sudden unexpected death
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Simone G. Ramos

E-Mail Website
Guest Editor
Departamento de Patologia e Medicina Legal, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 14049-900 Ribeirão Preto, SP, Brazil
Interests: cardiovascular pathology; post-mortem investigation; autopsy; perinatal pathology; sudden unexpected death; sudden cardiac death; sudden infant death syndrome; cardiac conduction system; general pathology; surgical pathology; pulmonary pathology

Special Issue Information

Dear Colleagues, 

This Special Issue of Diagnostics addresses the scope of the practice of autopsy for medical diagnostics.

Autopsy is the post-mortem examination of the deceased body and organs to determine the cause of death and to study the pathological changes. Autopsy is an anatomopathological professional activity that requires a high level of technical ability and knowledge for its performance and interpretation.

The importance of post-mortem investigations for the documentation of cause of death will be discussed in this Special Issue, including the expanding roles of molecular autopsy. The indications and dissection techniques of autopsy will also be reviewed in this Special Issue, along with interpretations of post-mortem findings, described in relation to clinical diagnostics, with discussions about clinicopathological correlations. The role of the pathologist, especially the cardiovascular pathologist, will be discussed in terms of the evaluation of cause of death. The objectives of autopsy will be considered, including assessments of the validity and appropriateness of diagnostic, medical, and surgical procedures. The provision of information to the patient’s relatives, to colleague physicians, to society at large, and to medical literature, as discovered during the evaluation of subjects that died suddenly and unexpectedly, will also be addressed.

Basic information on virtual autopsies based on diagnostic imaging studies will be provided. The increasing need for quality assurance in relation to autopsies, medical education, and training will also be presented. The teaching of autopsy procedures is “vital” in preserving and increasing medical knowledge, in order to diminish undiagnosed medical illnesses, as stated in an old Latin aphorism: “Hic mors gaudet surrurrere vitae”, literally: “Here death is pleased to help life”.

Dr. Giulia Ottaviani
Prof. Dr. Simone G. Ramos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • autopsy
  • post-mortem investigation
  • cardiovascular pathology
  • sudden cardiac death
  • sudden unexpected death
  • perinatal autopsy
  • molecular autopsy
  • virtual autopsy

Published Papers (5 papers)

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16 pages, 5318 KiB  
Article
Autopsy for Medical Diagnostics: Finding the Cause of Sudden Unexpected Death through Investigation of the Cardiac Conduction System by Serial Sections
by Giulia Ottaviani and Simone G. Ramos
Diagnostics 2023, 13(11), 1919; https://doi.org/10.3390/diagnostics13111919 - 31 May 2023
Cited by 2 | Viewed by 1225
Abstract
Sudden unexpected death (SUD) is a fatal event that occurs in an apparently healthy subject in a way that such an abrupt outcome could have not been predicted. SUD—including sudden intrauterine unexplained death (SIUD), sudden neonatal unexpected death (SNUD), sudden infant death syndrome [...] Read more.
Sudden unexpected death (SUD) is a fatal event that occurs in an apparently healthy subject in a way that such an abrupt outcome could have not been predicted. SUD—including sudden intrauterine unexplained death (SIUD), sudden neonatal unexpected death (SNUD), sudden infant death syndrome (SIDS), sudden unexpected death of the young (SUDY), and sudden unexpected death in the adult (SUDA)—occurs as the first manifestation of an unknown underlying disease or within a few hours of the presentation of a disease. SUD is a major unsolved, shocking form of death that occurs frequently and can happen at any time without warning. For each case of SUD, a review of clinical history data and performance of a complete autopsy, particularly focused on the study of the cardiac conduction system, were carried out according to the necropsy protocol devised by the Lino Rossi Research Center, Università degli Studi di Milano, Italy. Research cases collected and selected for this study were represented by 75 SUD victims that were subdivided into 15 SIUD, 15 SNUD, 15 SUDY, and 15 SUDA victims. After a routine autopsy and clinical history analysis, death remained unexplained, and hence a diagnosis of SUD was assigned to 75 subjects, which included 45 females (60%) and 30 (40%) males ranging in age from 27 gestational weeks to 76 years. Serial sections of the cardiac conduction system disclosed frequent congenital alterations of the cardiac conduction system in fetuses and infants. An age-related significant difference in distribution among the five age-related groups was detected for the following anomalies of the conduction system: central fibrous body (CFB) islands of conduction tissue, fetal dispersion, resorptive degeneration, Mahaim fiber, CFB cartilaginous meta-hyperplasia, His bundle septation, sino-atrial node (SAN) artery fibromuscular thickening, atrio-ventricular junction hypoplasia, intramural right bundle branch, and SAN hypoplasia. The results are useful for understanding the cause of death for all SUD cases that were unexpected and would have otherwise remained unexplained, so as to motivate medical examiners and pathologists to perform more in-depth studies. Full article
(This article belongs to the Special Issue Autopsy for Medical Diagnostics 2.0)
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12 pages, 1552 KiB  
Article
Increased Epicardial Adipose Tissue (EAT), Left Coronary Artery Plaque Morphology, and Valvular Atherosclerosis as Risks Factors for Sudden Cardiac Death from a Forensic Perspective
by Timur Hogea, Bogdan Andrei Suciu, Adrian Dumitru Ivănescu, Cosmin Carașca, Laura Chinezu, Emil Marian Arbănași, Eliza Russu, Réka Kaller, Eliza Mihaela Arbănași, Adrian Vasile Mureșan and Corina Carmen Radu
Diagnostics 2023, 13(1), 142; https://doi.org/10.3390/diagnostics13010142 - 01 Jan 2023
Cited by 10 | Viewed by 1936
Abstract
Background: In sudden cardiac deaths (SCD), visceral adipose tissue has begun to manifest interest as a standalone cardiovascular risk factor. Studies have shown that epicardial adipose tissue can be seen as a viable marker of coronary atherosclerosis. This study aimed to evaluate, from [...] Read more.
Background: In sudden cardiac deaths (SCD), visceral adipose tissue has begun to manifest interest as a standalone cardiovascular risk factor. Studies have shown that epicardial adipose tissue can be seen as a viable marker of coronary atherosclerosis. This study aimed to evaluate, from a forensic perspective, the correlation between body mass index (BMI), heart weight, coronary and valvular atherosclerosis, left ventricular morphology, and the thickness of the epicardial adipose tissue (EAT) in sudden cardiac deaths, establishing an increased thickness of EAT as a novel risk factor. Methods: This is a retrospective case–control descriptive study that included 80 deaths that were autopsied, 40 sudden cardiac deaths, and 40 control cases who hanged themselves and had unknown pathologies prior to their death. In all the autopsies performed, the thickness of the epicardial adipose tissue was measured in two regions of the left coronary artery, and the left ventricular morphology, macro/microscopically quantified coronary and valvular atherosclerosis, and weight of the heart were evaluated. Results: This study revealed a higher age in the SCD group (58.82 ± 9.67 vs. 53.4 ± 13.00; p = 0.03), as well as a higher incidence in females (p = 0.03). In terms of heart and coronary artery characteristics, there were higher values of BMI (p = 0.0009), heart weight (p < 0.0001), EAT of the left circumflex artery (LCx) (p < 0.0001), and EAT of the left anterior descending artery (LAD) (p < 0.0001). In the multivariate analysis, a high baseline value of BMI (OR: 4.05; p = 0.004), heart weight (OR: 5.47; p < 0.001), EAT LCx (OR: 23.72; p < 0.001), and EAT LAD (OR: 21.07; p < 0.001) were strong independent predictors of SCD. Moreover, age over 55 years (OR: 2.53; p = 0.045), type Vb plaque (OR: 17.19; p < 0.001), mild valvular atherosclerosis (OR: 4.88; p = 0.002), and moderate left ventricle dilatation (OR: 16.71; p = 0.008) all act as predictors of SCD. Conclusions: The data of this research revealed that higher baseline values of BMI, heart weight, EAT LCx, and EAT LAD highly predict SCD. Furthermore, age above 55 years, type Vb plaque, mild valvular atherosclerosis, and left ventricle dilatation were all risk factors for SCD. Full article
(This article belongs to the Special Issue Autopsy for Medical Diagnostics 2.0)
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12 pages, 1781 KiB  
Article
Pathological Changes in the Lungs of Patients with a Lethal COVID-19 Clinical Course
by Valters Viksne, Ilze Strumfa, Maris Sperga, Janis Ziemelis and Juris Abolins
Diagnostics 2022, 12(11), 2808; https://doi.org/10.3390/diagnostics12112808 - 15 Nov 2022
Cited by 1 | Viewed by 1632
Abstract
The novel coronavirus SARS-CoV-2 was identified in 2019 and quickly became the cause of the fifth worst pandemic in human history. Our goal for this research paper was to examine the morphology of the lungs in 88 patients that died from COVID-19 in [...] Read more.
The novel coronavirus SARS-CoV-2 was identified in 2019 and quickly became the cause of the fifth worst pandemic in human history. Our goal for this research paper was to examine the morphology of the lungs in 88 patients that died from COVID-19 in Latvia, thus increasing the data available about the histological characteristics of SARS-CoV-2-induced disease. Lung tissue samples from 88 autopsies were visualized in hematoxylin–eosin and assessed by light microscopy. The male-to-female ratio was 56:32, and the mean age was 62 years ± 15.5 years (22–94 years). Clinically important laboratory data were assessed, including leucocyte count, CRP (C-reactive protein) and D-dimer levels. Signs of diffuse alveolar damage were found in 83/88 (94.3%; 95% CI 87.0–97.9) of patients, 38/88 (43.2%; 95% CI 33.3–53.6) in the exudative phase, and 45/88 (51.1%; 95% CI 40.8–61.3) in the proliferative phase. Vascular damage was identified in 70/88 (79.5%; 95% CI 69.9–86.7) of patients, and 83/88 (94.3%; 95% CI 87.0–97.9) had signs of thrombosis. A sparse inflammatory infiltrate of lymphocytes and macrophages was a common finding aside from cases with an identified coinfection. Eighty patients had significant co-morbidities, including coronary heart disease (49), primary arterial hypertension (41), and diabetes mellitus (34). Since our group’s demographic profile and spectrum of co-morbidities were analogous to other reports, the histological findings of marked diffuse alveolar damage, widespread vascular lesions, and active thrombosis can be considered representative of severe COVID-19. Full article
(This article belongs to the Special Issue Autopsy for Medical Diagnostics 2.0)
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8 pages, 1427 KiB  
Case Report
Minimally Invasive Tissue Sampling via Post Mortem Ultrasound: A Feasible Tool (Not Only) in Infectious Diseases—A Case Report
by Akhator Terence Azeke, Julia Schädler, Benjamin Ondruschka, Stefan Steurer, Dustin Möbius and Antonia Fitzek
Diagnostics 2023, 13(16), 2643; https://doi.org/10.3390/diagnostics13162643 - 10 Aug 2023
Viewed by 973
Abstract
In the past years the number of hospital autopsies have declined steadily, becoming almost excluded from medical training. Medicolegal (forensic) autopsies account for almost all autopsies, whereas hospital autopsies are becoming increasingly rare. Minimally invasive tissue sampling (MITS) using post mortem ultrasound offers [...] Read more.
In the past years the number of hospital autopsies have declined steadily, becoming almost excluded from medical training. Medicolegal (forensic) autopsies account for almost all autopsies, whereas hospital autopsies are becoming increasingly rare. Minimally invasive tissue sampling (MITS) using post mortem ultrasound offers the opportunity to increase the number of post mortem examinations in a clinical and even forensic context. MITS is a needle-based post mortem procedure that uses (radiological) imaging techniques to examine major organs of the body, acquire tissue samples and aspirate fluid from the body cavities or hollow organs. In this study, MITS was used to determine the presence of other co-existing diseases in a deceased infected 97-year-old woman with severe acute respiratory syndrome coronavirus 2. The examination of her body was carried out using ultrasound as an imaging tool and to gather ultrasound-guided biopsies as conventional autopsy was rejected by the next of kin. Ultrasound and histology identified an intravesical mass leading to an obstruction of the urinary outlet resulting in bilateral hydronephrosis and purulent pyelonephritis, which was unknown during her lifetime. Histopathological examination revealed the tumor mass to be a squamous cell carcinoma. This study has shown that MITS can be used to determine the cause of death and the presence of concomitant diseases in the infectious deceased. Full article
(This article belongs to the Special Issue Autopsy for Medical Diagnostics 2.0)
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19 pages, 600 KiB  
Systematic Review
Post-Mortem Interval and Microbiome Analysis through 16S rRNA Analysis: A Systematic Review
by Pamela Tozzo, Irene Amico, Arianna Delicati, Federico Toselli and Luciana Caenazzo
Diagnostics 2022, 12(11), 2641; https://doi.org/10.3390/diagnostics12112641 - 31 Oct 2022
Cited by 6 | Viewed by 1949
Abstract
The determination of the Post-Mortem Interval (PMI) is an issue that has always represented a challenge in the field of forensic science. Different innovative approaches, compared to the more traditional ones, have been tried over the years, without succeeding in being validated as [...] Read more.
The determination of the Post-Mortem Interval (PMI) is an issue that has always represented a challenge in the field of forensic science. Different innovative approaches, compared to the more traditional ones, have been tried over the years, without succeeding in being validated as successful methods for PMI estimation. In the last two decades, innovations in sequencing technologies have made it possible to generate large volumes of data, allowing all members of a bacterial community to be sequenced. The aim of this manuscript is to provide a review regarding new advances in PMI estimation through cadaveric microbiota identification using 16S rRNA sequencing, in order to correlate specific microbiome profiles obtained from different body sites to PMI. The systematic review was performed according to PRISMA guidelines. For this purpose, 800 studies were identified through database searching (Pubmed). Articles that dealt with PMI estimation in correlation with microbiome composition and contained data about species, body site of sampling, monitoring time and sequencing method were selected and ultimately a total of 25 studies were considered. The selected studies evaluated the contribution of the various body sites to determine PMI, based on microbiome sequencing, in human and animal models. The results of this systematic review highlighted that studies conducted on both animals and humans yielded results that were promising. In order to fully exploit the potential of the microbiome in the estimation of PMI, it would be desirable to identify standardized body sampling sites and specific sampling methods in order to align data obtained by different research groups. Full article
(This article belongs to the Special Issue Autopsy for Medical Diagnostics 2.0)
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