Why to conduct an Autopsy

and Autopsy in infectious

diseases
D. N. Lanjewar
Sir J. J. Hospital, Mumbai
dnlanjewar2011@gmail.com
Plan of my talk
History and value of autopsy
Autopsy practices in India
Autopsy in infectious
diseases
Summary and conclusions
This is the place where
death delights to serve
the living
Dead
Men Tell
No Tales
The rise and fall of
Autopsy
1800s: Clinicians performed autopsies
1900s: Data base of modern medicine
is formed on the basis of autopsy
First half of 20 th century autopsy
became province of pathologist
Sir William Osler (1800)
Autopsy at the
center of
education
Death could be
well utilised to
enrich the lives
of living
JACOBI (1900 )
International Medical Congress in Chicago
The practice of modern medicine is not only
diagnosis & autopsy but the treatment and
care of patient
So highly valued was the autopsy in 1900
that it was thought equal to diagnosis.
Autopsy in India
Medical Institutes Year
Established
Year of First
Autopsy
Kolkata Medical College 1837 1837
Grant Medical College,
Mumbai
1845 (GGMC)
1912 (MBBS) 1882
Topiwala National Medical
College, Mumbai
1921 (Ayurvedic)
1946 (MBBS) 1959
GSMC, Mumbai 1925 (MBBS) 1935
LTMMC, Mumbai 1964 (MBBS) 1965
PGIMER, Chandigarh 1962 (PG) 1963
NIMHANS, Bangalore 1975 (CNS) 1975
Bengal(Calcutta)Medical College
1840 Creation of Pathology Museum
Specimens were from Aden, Singapore,
Madras and Himalayan range
Dr. Allan Webb (Professor of Descriptive and
surgical anatomy) published a book
PATHOLOGIA INDICA in 1848
The book contains extensive autopsy studies
with short clinical notes and treatment
prescribed
Leadership of autopsy
Pathology in Mumbai
Prof. P. V. Gharpure
Gharpure PV, Jhala HI. The relationship
of the body weight to the weights of
the organs: The Brain; Ind Med Gaz:
1950;85:342-3.
Other Leaders: Dr. R. K. Gadgil,
Dr. Rananaware, Dr. Suman Kinare, Dr.
U. L. Wagholikar, Dr. K. P. Deodhar
Contribution of Indian Autopsy Studies
Kolkata medical College
Gharpure P. V.
Aikat BK: Hepatic pathology
Dastur DK: CNS TB and Neuropathology
Kinare SG: Aortic arteritis and CVS Pathology
Datta BN: Cardiovascular pathology
Wagholikar UL: Renal cortical necrosis due to
Diethyline Glycol poisoning
Deodhar KP: Liver pathology
S.K. Shankar: Neuropathology
Lanjewar DN: Pathology of HIV/AIDS
Autopsy: How it helps?
Identify, Interpret, Extent, Correlate
Explain Clinical, Radiological and
Laboratory findings
Discrepancy between AM & PM diagnosis
Discover new/unrecognized diseases
Detect new pattern in old diseases
Surveillance of diseases
Research
Recognition and Analysis of lesions
The Wormy World
3 years male child with diarrhea, vomiting of
worms, died due to respiratory distress
Story of 1989: Autopsies in two cases
M/35 and M/47 Clinical Diagnosis P C J
Clinically
Unsuspecte
d TB in both
cases
One case
showed
TB
abscesse
s in
Spleen
Discovery of Unrecognized Diseases
CNS Toxoplasmosis
To detect new pattern in old diseases
TB Abscesses in Spleen
Autopsy rates in various Eras
Year Autopsy %
1940 50%
1980 14%
Currently Less than 5%
Autopsy rates in some centers
Institutes 2005 2006 2007 2008 2009
GMC 356 321 074 041 030
GSMC 1015 1156 1210 892 940
TNMC 279 626 652 287 301
LTMMC 743 414 381 695 566
PGIMER 729 626 652 643 602
NIMHANS
(Brain)
051 063 053 049 045
Student, Staff, Surgical CPC, Perinatal Meetings, Autopsy conference
GOVERNMENT MEDICAL COLLEGE, AURANGABAD
GRANT MEDICAL COLLEGE & SIR J.J. HOSPITAL, MUMBAI
PATHOLOGY SCHOOL
Passion for Autopsy
Prof. U. L. Wagholikar and myself
Before 1988: Autopsy Practices
AIDS story 1988
Skin and STD Department
May 5, 1988
35 years, commercial sex
worker
Admitted for severe weight
loss
ELISA for HIV-1: Reactive
Western blot: Reactive
Clinical diagnosis: Abdominal
TB
June 20, 1988
Died 45 days after
hospitalization
PM requested to confirm
AIDS or otherwise
Protective Clothing (first PM)
Cut surface lung and capsular surfaces kidneys
PM 364/88
Museum of Microorganisms
Crypto
A FB
C MV
Crypto
Lessons Obtained from the case
In patients with AIDS organs can
remain normal despite presence of
extensive organisms
All diseases in patient with AIDS can
not be well recognized clinically
Diagnosis in AIDS is not complete
without the help of histopathology and
special stains
HIV Autopsy: Dress up
June, 1988 December, 1988 1991
Infections likely to be transmitted in
autopsy room
Mycobacterium Tuberculosis
Hepatitis B (With vaccination, infection
minimized)
Hepatitis C (More worrisome)
HIV infection
Inhalation (Cryptococcus, PCP, Candida, MAI)
Ubiquitous may not cause disease unless
immunocompromised
Immunocompramised staff should not be working
in mortuary
Recovery of HIV from Cadavers
Postmortem recovery of HIV-I from Plasma & Mononuclear cells. Arch
Pathol lab Med 1992;116:1124-7.(21/41-50% Cases, virus found up to
21.5 Hrs)
Recovery of HIV at Necropsy. N Eng J Med;1989,321:
1833- 4. (18 hrs. to 11 days)
Long lasting viability of HIV after patients death. Lancet 1991;338:63.
Isolation of HIV at necropsy one to six days postmortem. Am j Clin
Pathol1990,94;422-25
HIV-2 cultured from blood 16 days after death. Lancet1993;341:1342-3.
Spleen specimens stored up to 14 days recovered HIV
Cadavers assumed to contain viable HIV infection
Risk of performing Necropsies
in HIV infected cadavers
Infection might arise from Contact of
blood or body fluids
Penetrating percutaneous injuries from
bone specules, Scalpel blades, Syringe
needles and sewing needle
Infected aerosols of infected fluids or sawn
bone dust
Acquiring HIV from Necropsy
No Reports of pathologists
3 Morgue technicians / Embalmer in USA and
3 from Mumbai are stated to have possible
occupation related HIV infection
No further details of these cases are available
Experiences of Pathologists who have
done many HIV necropsies
Provide wealth of Macroscopic pathology
Excellent material for teaching, CPC
Provide more satisfaction to pathologists
than routine necropsies
Pathologists get intellectual pleasure in
the material he or she studies
Pathologists have a role in management
Comments of pathologists (1992)
30 Pathologists from Great Britain
agreed
HIV necropsies are safe when
carried sensibly
Mortuary practices
Geller SA. The autopsy in acquired immunodeficiency syndrome.
How and why? Arch Pathol Lab Med 1990;114:324-9.
No different from those used for all cases
Good work practices
Use of safe implements
Safe working environment
Wearing face mask, glasses, wearing water
impermeable gown, plastic over apron, wearing
two pairs of gloves (latex or cut resistant glove
liners
Autopsy Instruments
Minimum instruments
Blunt ended
Round ended scissors
Non pointed knife blades
Non pointed organ slicing knives
Autopsy: Central role in diagnosis
and Research
Legionnaires' disease
Hantavirus
HIV
Ebola virus
FUTURE OF AUTOPSIES
There is enough scope for surprises in
the postmortem room.
The pathologist would be able to offer
the final word
Summary and Conclusions
History and advantages of autopsies and
autopsies in Infectious diseases
The decline in autopsy is a progressive and
the the blame lies, at least in part, at our own
door (The pathologists)
HIV necropsy provides valuable information
and if these autopsies are performed
sensibly, there are less chances of HIV
transmission