PATHOLOGIST... and in the end, you see what happened.

Transcription

1 PATHOLOGIST... and in the end, you see what happened. This wooden figurine of RudolfVirchow stood in a pawn shop in the Bronx, New York City. Literally translated, the inscription says: "Pathologist-and in the end stands success," which seems to mean here, success in discovering the cause of diseases.

2 Handbook of Autopsy Practice 3rd Edition Jurgen Ludwig, MD Emeritus Consultant, Department of Laboratory Medicine and Pathology, Mayo Clinic; Emeritus Professor of Pathology, Mayo Medical School, Rochester, MN SPRINGER SCIENCE+BUSINESS MEDIA, LLC

3 Copyright 2002 Springer Science+Business Media New York Originally published by Humana Press Inc. in 2002 AII rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the the Mayo Foundation. As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The authors and publisher have made ali reasonable attempts to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents ofthe book. Any practice described in this book should be applied by the reader in consultation with a physician and taking regard ofthe unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new inforrnation regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Nothing in this publication implies that Mayo Clinic endorses the products or equipment mentioned in this book. AII articles, comments, opinions, conclusions, or recommendations are those of the author(s) and do not necessarily reflect the views of the publisher or of Mayo Clinic. This publication is printed on acid-free paper. ANSI Z (American Standards Institute) Permanence of Paper for Printed Library Materials. Acquisitions Editor: Thomas H. Moore. Cover design by Patricia F. Cleary. Production Editor: Mark J. Breaugh. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Springer Science+Business Media, LLC. provided that the base fee ofus $10.00 per copy, plus US $00.25 per page, is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Springer Science+Business Media, LLC. The fee code for users of the Transactional Reporting Service is: [ /02 $ $00.25]. Library of Congress Cataloging in Publication Data Handbook of autopsy practice / edited by Jurgen Ludwig.--3rd ed. p. ;cm Rev. ed. of: Current methods of autopsy practice / Jurgen Ludwig. 2nd ed lncludes bibliographical references and index. ISBN ISBN (ebook) DOI / Autopsy. I. Ludwig, Jurgen, II. Ludwig, Jurgen, Current methods of autopsy practice. [DNLM: 1. Autopsy--methods. QZ 35 H ] RB57.L o7'59--dc

4 Preface The second edition of Handbook of Autopsy Practice appeared in 1979 under the title Current Methods of Autopsy Practice (W. B. Saunders Company); that edition was out of print in the early 1980s. Now, over 20 years later, it appeared timely to thoroughly update the material in a third edition by adding what we have learned in the meantime and eliminating text that has become obsolete. There is an acute need for a complete and readily accessible resource for autopsy work because few pathologists still specialize in autopsy practice and, as a consequence, expertise in autopsy technology and autopsy pathology has declined. Our colleagues in the forensic field have remained the only large group of autopsy practitioners. For most other pathologists, the economic situation, time constraints, and the steadily decreasing autopsy rates have made a career in autopsy pathology unattractive. This state of affairs is perpetuated by a lack of interest among many of our young colleagues, partly because the teaching of autopsy pathology and autopsy techniques during most residencies is insufficient. Numerous articles have bemoaned this situation, but the trend, I fear, is irreversible. Still, autopsies will be requested, particularly in complex and difficult situations where the questions remaining after the death of the patient might challenge even experienced autopsy pathologists. Under these circumstances, this Handbook of Autopsy Practice should meet a particular need by providing the prosector with a source of information when it is most required-in the autopsy room. Thus, the text is written primarily for practicing pathologists with at least some autopsy experience; this is not an introductory teaching manual. The principal organization of the original book has been maintained. Part I is a general text on autopsy methods and all their corollary activities. This part has been updated but also shortened considerably because many methods that were described in detail in the second edition have become obsolete - partly because of the decline of the classical pathology museums, partly because of our increased awareness of the toxic hazards of many chemicals that were used in pathology museums of only a few decades ago. Files of 35-mm slides or disks with digitalized images have largely replaced the museum because funds are lacking-museum space and personnel are costly-and also because interest in museum-type specimen display has waned. We have lost something here, no doubt, but a realistic evaluation of the situation caused me to condense Part 1. Nevertheless, many old references were reprinted so that access to the classical techniques would not become too difficult. At the same time, some new developments needed to be addressed, such as the principles of quality assurance and the increased safety precautions that were prompted by the resurgence of potentially fatal infectious diseases. Part II represents the most important resource during work in the autopsy room by providing tabulations of technical procedures recommended in specific diseases or conditions and by listing expected findings in these situations. Thus, the authors assumed that one or several clinical diagnoses had been rendered, and on this basis, we tabulated the "what to look for" and the "how to dissect and preserve it." Part III concludes with updated tabulations of weights, measurements, and related data. Major changes include the combination of several tables from the second edition with data from fetuses, infants, and children. Most cardiac weights and measurements were culled from current sources. I acknowledge with pleasure the contributions of Mr. Darrell Ottman and his fellow technologists, and of all colleagues, past and present, in the Mayo Clinic Autopsy Service. Many colleagues in other Mayo Clinic Departments, and in institutions outside the Mayo Clinic, provided much helpful advice. Drs. Lawrence J. Burgart and Jeffrey L. Myers, both from the Mayo Clinic Division of Anatomic Pathology, critically reviewed the text in Part II on many hematological and respiratory disorders, respectively. I am particularly indebted to Dr. Hagen Blaszyk who, in addition to compiling the weight tables, provided much needed support during the preparation of the manuscript. Drs. Thomas V. Colby from Mayo Clinic Scottsdale and Theresa S. Emory at the Armed Forces Institute of v

5 VI PREFACE Pathology helped with the compilation of addresses of tumor and disease registries. Dr. Wayne Duer and Dr. Julia Martin, both from the Hillsborough County Medical Examiner Department, contributed to the discussion of toxicological autopsies and rape cases, respectively. We hope that the book will serve its purpose. I also would like to thank Mr. Thomas H. Moore and his colleagues at Humana Press for their expert support. Jurgen Ludwig, MD

6 Contents Preface... v Contributors... ix PART I: AUTOPSY TECHNIQUES, LABORATORY PROCEDURES, AND DATA PROCESSING Principles of Autopsy Techniques, Immediate and Restricted Autopsies, and Other Special Procedures Jurgen Ludwig Medicolegal Autopsies and Autopsy Toxicology Vernard I. Adams Cardiovascular System William D. Edwards Tracheobronchial Tree and Lungs Jurgen Ludwig Esophagus and Abdominal Viscera Jurgen Ludwig Nervous System Caterina Giannini and Haruo Okazaki The Eye and Adnexa R. Jean Campbell Skeletal System Jurgen Ludwig Autopsy Microbiology Brenda L. Waters Chromosome Study of Autopsy Tissues Gordon W. Dewald Autopsy Chemistry Vernard I. Adams vii

7 VIII CONTENTS 12 Autopsy Roentgenology and Other Imaging Techniques Jurgen Ludwig Autopsy of Bodies Containing Radioactive Materials Kelly L. Classic Fixation, Color Preservation, Gross Staining, and Shipping of Autopsy Material Jurgen Ludwig and Brenda L. Waters Museum Techniques and Autopsy Photography Jurgen Ludwig and William D. Edwards Organization, Maintenance, and Safety Concerns of the Autopsy Service; Tissue Registries; Interviews With the Next of Kin Jurgen Ludwig Autopsy Documents, Data Processing, and Quality Assurance Jurgen Ludwig Autopsy Law Vernard I. Adams and Jurgen Ludwig The State of Autopsy Practice: An Annotated Bibliography Jurgen Ludwig PART II: ALPHABETIC LISTING OF DISEASES AND CONDITIONS Jurgen Ludwig with Vernard I. Adams (Medicolegal and Toxicologic cases), William D. Edwards (Cardiovascular cases), Caterina Giannini (Neuropathologic cases), and Brenda L. Waters (Pediatric and Infectious Disease cases) Organization of Part II Special Histological Stains Listing PART III: NORMAL WEIGHTS AND MEASUREMENTS Weights and Measurements Hagen Blaszyk, Jurgen Ludwig, and William D. Edwards Weights and Measurements in Fetuses, Infants, Children, and Adolescents Weights and Measurements in Adults Index

8 Contributors VERNARD I. ADAMS, MD Medical Examiner Department, Hillsborough County; Department of Pathology and Laboratory Medicine, University of South Florida, Tampa, FL HAGEN BLASZYK, MD Department of Pathology and Laboratory Medicine, MCHV Campus, University of Vermont, Burlington, VT R. JEAN CAMPBELL, MD Division of Anatomic Pathology, Mayo Clinic, Rochester, MN KELLY L. CLASSIC, MS Section of Safety, Mayo Clinic, Rochester, MN GORDON W. DEWALD, PhD Division of Laboratory Genetics, Mayo Clinic, Rochester, MN WILLIAM D. EDWARDS, MD Division of Anatomic Pathology, Mayo Clinic, Rochester, MN CATERINA GIANNINI, MD Division of Anatomic Pathology, Mayo Clinic, Rochester, MN JURGEN LUDWIG, MD Division of Anatomic Pathology, Mayo Clinic, Rochester, MN HARUO OKAZAKI, MD Division of Anatomic Pathology, Mayo Clinic, Rochester, MN BRENDA L. WATERS, MD Department of Pathology and Laboratory Medicine, MCHV Campus, University of Vermont, Burlington, VT IX