Commonly considered additional autopsy examinations include chemical/toxicological analysis of intestines and body fluids as well as histopathological/microscopic examination of various organs. Clinical autopsies have two main purposes. They are carried out to better understand pathological processes and determine what factors contributed to the death of a patient. For example, material may be collected for the study of infectious diseases during an autopsy. [14] Autopsies are also performed to ensure the quality of care in hospitals. Autopsies can shed light on how to prevent patient death in the future. For example, a medico-legal autopsy is performed when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in the case of unknown or uncertain death or for research purposes. Autopsies can be classified in more detail in cases where an external examination is sufficient and in those where the body is dissected and an internal examination is performed. In some cases, the permission of the next of kin may be required for the internal autopsy. Once the internal autopsy is complete, the body is reconstituted by being stitched together. The consensual (hospital) autopsy rate in the UK and around the world has declined rapidly over the past 50 years. In the UK, only 0.7% of adult inpatient deaths followed a consensual autopsy in 2013.
[17] Conducting a forensic autopsy as part of the inquest into the death is of paramount importance in understanding the circumstances of the death in any civilized society. In many jurisdictions around the world, a forensic autopsy is required for non-natural deaths, sudden natural deaths, and deaths in suspicious or unusual circumstances. Although the forensic death screening system and forensic autopsy standards vary from country to country, the objectives remain the same in the first place. A large meta-analysis revealed that about a third of death certificates are incorrect and half of the autopsies performed resulted in results that were not suspected before the person`s death. [8] It is also believed that more than a fifth of unexpected results are only histological, i.e. by biopsy or autopsy, and that about a quarter of unexpected results or 5% of all results are serious and can also only be diagnosed from tissue. The objectives of a medico-legal autopsy differ from case to case and may be specific to a particular case. Nevertheless, in general, the following purposes of performing a medico-legal autopsy are: In addition to a complete and meticulous dissection of the corpse, the following elements should also be taken into account in the context of a medico-legal autopsy: There are different schools regarding the procedure beyond this point. In one method, each organ is removed separately for incision and study. In so-called mass methods, all the thoracic organs of the same group and all the abdominal organs of another are removed for examination. The large vessels on the neck, head and arms are ligated – attached – and the organs are removed as a dissection unit.
Cervical organs are studied only on the spot or removed from below. Dissection then usually proceeds from behind, unless the results dictate a variation in the procedure. As a rule, groups of organs are removed together, so disturbances in their functional relationships can be detected. After studying the brain in position, it is released from its attachments and removed in toto. The spinal cord can also be removed. A stroke autopsy may be able to determine the time between the onset of cerebral infarction and the time of death. An important part of the autopsy is the reconstruction of the body, so that, if desired, it can be visited by the relatives of the deceased after the procedure. After the examination, the body has an open and empty chest cavity with open chest valves on both sides, the top of the skull is missing, and the valves of the skull are pulled on the face and neck.
It is unusual to examine the face, arms, hands or legs inside. The dissection of human remains for medical or scientific reasons was also practiced irregularly after the Romans, for example by the Arab doctors Avenzoar and Ibn al-Nafis. In Europe, they were carried out with sufficient regularity to be qualified as early as 1200, and successful efforts to preserve the body by filling the veins with wax and metals. [27] Until the 20th century,[27] the modern autopsy process was thought to be derived from Renaissance anatomists. Giovanni Battista Morgagni (1682-1771), celebrated as the father of pathological anatomy,[28] wrote the first comprehensive work on pathology, De Sedibus et Causis Morborum per Anatomen Indagatis (The seats and causes of diseases of the examined anatomy, 1769). [1] The dissection of a corpse by a forensic pathologist or a physician legally authorized to determine the cause and timing of a death that appears to be due to non-natural causes. Autopsies document the pathological processes that were present at the time of the patient`s death, and most autopsies do not indicate an immediate or immediate cause of death. These factors are important in medico-legal cases and are often necessary in the analysis of the autopsy, even in situations where an autopsy itself is not required by law. Once all studies – histological, chemical, toxicological, bacteriological and viral – are completed, all errors in preliminary anatomical diagnoses are corrected and the final anatomical diagnoses and the final cause of death are listed. An analytical statement of the autopsy, which correlates the results with the clinical picture, the „clinical-pathological correlation“, completes the autopsy record. Medical investigators are trying to determine the time of death, the exact cause of death, and what, if any, preceded the death, such as a fight.
A medico-legal autopsy may involve obtaining biological samples from the deceased for toxicological testing, including stomach contents. Toxicological tests may reveal the presence of one or more chemical „poisons“ (all chemicals in sufficient quantities can be classified as poisons) and their quantity. Because the post-mortem deterioration of the body, as well as the gravitational accumulation of bodily fluids, necessarily alter the physical environment, toxicological tests may overestimate rather than underestimate the amount of suspected chemical. [13] Establishing the identity of the deceased is of paramount importance during a medico-legal autopsy on an unknown corpse. Sometimes it is also important to confirm the identity of the deceased. A systematic review of autopsy studies found that in about 25% of autopsies, a major diagnostic error is revealed. [7] However, this rate has decreased over time, and the study suggests that in a modern American institution, 8.4% to 24.4% of autopsies will detect major diagnostic errors. Nglish: Translation of the autopsy for Spanish speakers The body block that was used to lift the chest cavity is now used to lift the head. To examine the brain, an incision is made behind one ear, above the crown of the head, to a point behind the other ear.
When the autopsy is complete, the cut can be properly sewn and is not noticed when the head rests on a pillow in an open coffin. The scalp is removed from the skull in two valves, with the front flap passing over the face and the back valve passing over the neck. The skull is then cut with a circular (or semicircular) saber saw to create a „cap“ that can be removed and exposes the brain. The brain is then observed in situ. Then the brain`s connection to the cranial nerves and spinal cord is interrupted and the brain is lifted out of the skull for further examination.