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SOME GENERAL DEFINITION
PATHOLOGY
The branch of medical science that studies the causes and nature and
effects of diseases therefore pathology will not mean autopsy but other as biopsy of tissue to know what is going on , cytology as papsmears in one word anything that will be seen under microscope after tissue removal [surgery] is part of the pathology. Agood surgeon should be a good pathologist in understanding the disease and pathway.
PATHOLOGY: the
study of the reaction of the body to disease
DISEASE: any departure from a state of health
ANATOMIC PATHOLOGY: tissues and
organs
CLINICAL PATHOLOGY: blood and
other body fluids
FORENSIC PATHOLOGY: the application of the science and methods of pathology to the resolution
of problems of the law and issues of public interest

do you think a biopsy or FNA is needed
Thyroid wasn't even described in scientific literature until in 1656 Thomas Wharton
made a distinction between it and the larynx, but for 200 more years its
function (regulation of the body's metabolism) was completely unknown.
Goiters are excessive enlargements of the thyroid, which may be caused by
iodine deficiency, or by an excess of thyroid stimulating hormone. Because we
salt everything with iodized salt, iodine deficiency is never a problem in
America, but it is elsewhere in the world.
Below from http://www.co.pierce.wa.us/pc/abtus/ourorg/me/define.htm
I think it is a good historical and good definition on the subject
The term Coroner has been in use in England since about the year 900. It
derives from the term coruner (root word corona, Latin for crown, "officer of
the crown", meaning worked for the King). The position of Coroner has evolved
over the centuries as a public official responsible for the investigation and
certification of cause and manner of cases of sudden and unnatural death.
Much of American law derives from the English system and the office of the
Coroner has remained in use in the United States to date. The use of the office
of the Coroner varies widely throughout the U.S. Some are elected positions,
others are appointed. Many are open to lay persons, others require that the
Coroner be a physician, and a few require that the Coroner be a forensic
pathologist.
In the State of Washington, law directs that the investigation of sudden and
unnatural deaths take place within the 39 county jurisdictions. The system
varies from county to county. The counties that are smallest by population have
the elected Prosecuting Attorney also serve as Coroner. In most of the medium
sized counties, the Coroner is a separate elected office. In Washington there is
no requirement for the Coroner to be a physician. Currently (as of 1999), six
Washington counties have Medical Examiners rather than Coroners (Clark, King,
Pierce, Snohomish, Spokane, and Whatcom). Five of the counties (Clark, King,
Pierce, Snohomish, and Spokane) have forensic pathologists serving as the
Medical examiner.
MEDICAL EXAMINER

The concept of the Medical Examiner developed in 1877 in the State of
Massachusetts. The public was dissatisfied with layman Coroners and the system
changed to one of appointed physicians. One medical doctor was appointed to each
district (similar to a county jurisdiction) to be the public official
responsible for the investigation of sudden and unnatural death. Medical
examinations were a part of the investigation and the term AMedical Examiner@
has been in use since. The Medical Examiner concept is used in many states. All
are appointed, not elected positions, and all Medical Examiner=s are physicians,
but not necessarily trained in forensic pathology. The modern medical examiner
system developed in 1915 in New York City. A forensic pathologist was appointed
to be the Medical Examiner with statutory authority to investigate death and
provided with a dedicated facility, support staff, and toxicology laboratory.

FORENSIC PATHOLOGIST

Forensic pathology is a branch of medicine that applies the principles and
knowledge of the medical and related sciences to problems that concern the
general public and issues of the law. A forensic pathologist is a physician with
specialized medical and forensic science training and knowledge. In practice,
forensic pathologists concentrate closely on the understanding of types and
causation of injuries and causes of sudden and unnatural death. The American
Board of Pathology was established in 1936 and recognized forensic pathology as
a formal sub-specialty in 1958. Forensic pathologists are commonly involved in
death scene investigations, the performance of forensic autopsies (forensic
autopsies have a different focus than that of hospital autopsies conducted in
cases of natural death), review of medical records, interpretation of toxicology
and other laboratory studies, certification of sudden and unnatural deaths, and
court testimony in criminal and civil law proceedings.

DEATH CERTIFICATION

- (UNDERLYING) CAUSE OF DEATH: that disease or injury which initiates the
- sequence of events leading to, or ending in, death
- a competent underlying. cause of death should be etiologically
specific
- IMMEDIATE CAUSE OF DEATH: complications of the underlying cause
- CONTRIBUTORY CAUSE OF DEATH: diseases or injuries which make a physiologic
contribution to the death but do not result in the underlying cause
- MANNER OF DEATH: a description of how - under which circumstances -the cause
arose
- natural deaths: deaths caused exclusively by disease
- violent deaths: deaths caused fully or in part by injury
- subheadings of violent deaths:
- HOMICIDE: death at the hands of another
person or as the result of a hostile or illegal act of another person; does
not require an intent to kill but only a deliberate act - SUICIDE: death
at the hands of oneself; an intentionally self-destructive act; it is the
only manner of death which requires intent -ACCIDENT: violent deaths
occurring not as a result of a deliberate or illegal act of another
person; no definitive demonstration of intent to do harm - UNDETERMINED:
inconclusive manner of death; violence cannot be ruled out
- independence of medicolegal death certification from the criminal justice
system:
- HIT AND RUN FATALITIES -- Medical Examiner certifies as
accident; still prosecutable by law enforcement - VIOLENT DEATHS
OCCURRING DURING PURSUIT OF A FLEEING SUSPECT OR WHILE IN POLICE CUSTODY
-- Medical Examiner certifies as homicide; not necessarily punishable or
prosecutable in the legal system


to read the full report click here

MAJOR DIFFERENCES BETWEEN THE HOSPITAL AND FORENSIC AUTOPSY
- 1) authorization
- hospital: next of kin or individual responsible for burial arrangements
- forensic: Medical Examiner
2) purpose / objective(s)
- hospital: to confirm the cause of death or to evaluate the effects of
treatment of a disease
- forensic:
*to assist in ascertaining the manner of death
*to assist in reconstructing the fatal injury or event *to assist law
enforcement agencies in the prosecution of a crime *to document and preserve
evidence *to evaluate the possible contributions of natural disease and / or
drug intoxication in the causation of a violent death *to exclude or
rule out reasonable possibilities regarding the cause or manner of death
*to assist in matters of public health importance
3) focus
- hospital: internal examination, histology ;
- forensic: external, internal examinations, toxicology

suicide or murder
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AUTOPSY PATHOLOGY
1-the legal or forensic autopsy, destined
to investigate the the death in cases of violence or presumed
violence;
2-the verification of the cause of death,
performed in cases of non violent death without medical accompaniment and
3-the hospital autopsy, performed by
pathologists in hospitalized patients who died of natural causes
The autopsy goal is not only to
identify the cause of death, as many may think, but it has several other
functions:
-
Diagnosis and treatment quality control,
through the knowledge of the autopsy findings by the team that assisted the
patient, seeking to identify possible flaws and its causes, so that they won't
be repeated in other patients.
-
Source of information for the Secretary of
Health, allowing the making of precise statistics on the most frequent diseases,
what influences in the politics of health of the State and of the Municipal
district.
-
Material for the residents, students and
staff learning. The clinical-pathological correlation accomplished during all
autopsy stages of the is an excellent exercise, constituting the largest
knowledge source in Pathology.
-
Material for scientific research.
-
Recognition of new diseases and of new
lesion patterns.
-
Recognition of the effect of the treatment
in the evolution of the disease.
-
Clarify cases without clinical diagnosis
or in those in which the patient death was unexpected [http://www.uff.br/mpt/eautopsy.htm]
AUTOPSY REPORTS & THEIR
INTERPRETATION
The typical autopsy report is a two-pane sheet which looks
like the following:
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PATHOLOGICAL DIAGNOSIS:
Cardiovascular: Heart normal, no signs of hypertrophy,
valvular, or congenital abnormalities. Coronary arteries normal and distributed.
No right coronary predominance. Myocardium, no evidence of trauma, fibrosis, or
inflammation. Aorta, mild arteriosclerosis.
Respiratory: Larynx, trachea, and bronchi show no signs of
trauma or obstruction. Lungs, pulmonary congestion and edema present; upper
lobes have atypical obstruction.
Liver: No evidence of trauma or inflammation. Spleen: No
evidence of trauma Pancreas & Adrenal Glands: No significant
alterations. G.I. Tract: No evidence of trauma, hemorrhage, or
ulceration. Genitourinary Tract: Kidneys show no signs of trauma; Urinary
bladder and other organs in good condition. Head: Perforating gunshot wound
present
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Cause of Death: Perforating Wound to
Head:
Peritoneum: Intact, smooth
Heart: 415 gm. No gross evidence of trauma, some slight right
coronary predominance.
Lungs: Right 640 gm; Left 490 gm; all areas free of
obstruction except apex of upper lobes which show evidence of
scarring.
Liver: 1840 gm; Intact, some congestion Glands: No
significant alterations G.I. Tract: Stomach empty
Brain: 1575 mg; Perforating gunshot wound, entrance in right
superior to ear, oval wound 5/8" by 1/2" with rim of powder debris. Linear track
extends backward and to left, passing thru parietal lobe and left cerebrum,
exiting near left parietal bone. Multiple fractures on exit
side.
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INTERPRETATION
The anatomic patologists performs microscopic exams
including surgical pathology and frozen sections , cytopathology
, electron microscopy (400/year), children's autopsy and
adults' autopsy .

MEDICOLEGAL SCENE INVESTIGATION
- the death scene: the medical examiner has jurisdiction and presides over the
board ; but the law enforcement agency has ultimate jurisdiction over the
scene
- observation of the body: position, clothing
- estimation of the postmortem interval:
1) rigor mortis:
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Temperature of body
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Stiffness of body
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Time since death
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Warm
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Not stiff
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Not dead - more than three
hours
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Warm
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Stiff
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Dead between 3 to 8 hours
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Cold
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Stiff
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Dead between 8 to 36 hours
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Cold
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Not stiff
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Dead in more than 36
hours
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Rigor mortis should never be the only basis for
estimating time of death
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- Ca++ pumps run out of ATP
- Ca++ cannot be removed
- continuous contraction
- eventually tissues break down
- definition: the stiffening of the muscles after death due to chemical
changes in the muscle fibers (depletion of ATP, lowered pH)
- timetable:
- onset: 1/2-1 hr
- peak: 12 hr
- duration: 12 -36 hr
- disappearance: 24-36 hr (hot environment: 9 -12 hr)
- variables:
- accelerate rigor -- exercise; seizures; electrocution; heat (hyperthermia,
increased environmental temperature)
- retard rigor -- cold (hypothermia, decreased environmental temperature);
decreased muscle mass (elderly, disabled, emaciated, and young children
infants); some drugs/poisons (carbon monoxide)
- applications:
- actually a relatively crude indicator of the time of death
- if present in an antigravity position (position does not correlate with
surroundings), may indicate that the body was moved after the development of
rigor
2) livor mortis:(discoloration)

- definition: the red-purple discoloration caused by the settling of the blood
in the dependent portions of the body due to gravity -timetable:
- onset: minutes -few (2-4) hrs
- fixed: 8 -12 hrs - point at which livor cannot be displaced by blanching
(pressure) or by turning the body
- applications:
- time of death - also a crude indicator
- color may provide clue relating to cause or circumstances of death --
* cherry-red: carbon monoxide; cyanide; cold (refrigeration /
hypothermia) * green-brown: drugs or poisons causing
methemoglobin or sulfhemoglobin formation in the blood
- may indicate movement of the body after death (after development of livor);
a dual pattern may result if a body is moved after partial
development of livor
- mimics:
- contusion (bruise): bleeding into the tissues due to blunt force: will
not blanch with pressure
- suffusion: purple discoloration of face and neck due to obstructed venous
return of blood in hear failure or compression of the chest ("traumatic
asphyxia")
3) algor mortis:

- definition: cooling of the body after death
- timetable:
- first few hrs: 2.0-2.5 degrees F/hr
- first 12 hrs: 1.5-2.0 F/hr
- 12 -30 hrs: 1.0-1.5 F/hr
* plateau occurs at beginning and end of
cooling
- variables:
- environmental temperature
- body fat (decreased rate of heat loss)
- clothing (amount and type; affects rate of heat loss)
- active air currents - increase heat loss by convection
- body temperature at the time of death; one cannot assume that the
body temperature at the time of death is normal conditions resulting in
hyperthermia: infection/sepsis; hypermetabolic states; drugs; (cocaine, PCP,
amphetamines); vigorous activity conditions producing hypothermia: shock;
exposure to cold; drugs (alcohol)
- clues from the surrounding environment: furniture, food, medication, drugs,
electrical appliances
- activity: WHAT WAS THE DECEDENT DOING AT THE TIME OF THE FATAL EVENT
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The decomposition of a body can be divided into
several stages, even if the duration of each stage will vary a lot:
- 2-3 days: green staining begins on the right side
of the abdomen. Body begins to swell.
- 3-4 days: staining spreads. Veins go "marbled" - a
browny black discoloration
- 5-6 days: abdomen swells with gas. Skin blisters
- 2 weeks: abdomen very tight and swollen.
- 3 weeks: tissue softens. Organs and cavities
bursting. Nails fall off
- 4 weeks: soft tissues begin to liquefy. Face
becoming unrecognisable
- 4-6 months: formation of adipocere, if in damp
place. This is when the fat goes all hard and waxy.
- A body without a coffin will be decayed within 12
years.
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Stage
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Description
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Initial Decay
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Carcase appears fresh externally but is
decomposing internally due to the activities of bacteria, protozoa and nematodes
present in the animal before death
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Putrefaction
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Carcase swollen by gas produces internally,
accompanied by odour of decaying flesh
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Black putrefaction
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Flesh of creamy consistence with exposed parts
black. Body collapses as gases escapes. Odour of decay very strong
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Butyric fermentation
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Carcase drying out. Some flesh remains at
first, and cheesy odour develops. Ventral surface mouldy from
fermentation
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Dry decay
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Carcase almost dry; slow rate of decay
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IMMUNOHISTOCHEMISTRY
Immunohistochemical methods are based on
immunoenzimatic reactions using antibodies (mono or polyclonal) to detect cell
or tissue antigens,
Several possibilities exist of visualizing such
interactions, by using different enzymes (peroxidase, alkaline phosphatase,
etc.) or different cromogens (DAB, AEC, Fast RED, etc.).
TYPES OF DEATHS REQUIRING NOTIFICATION OF
THE MEDICAL EXAMINER
- all deaths due to violence, including accidents, suicides, and
homicides, or any deaths in which an injury is felt to be contributory to
the death; includes mechanical, electrical, thermal injuries, extremes of heat
and cold and atmospheric pressure, and intoxication by chemicals or drugs
- any sudden, unexpected, and/or unexplained death of an individual -
adult, child, or infant - in apparent good health
- deaths in custody: city or county jails, police custody, hospitalized
prisoners
- deaths occurring in the absence of a physician's attendance; specifically,
in the state of Michigan, death occurring more than 1 0 days after the deceased
was last seen by a physician (or if the physician is unable to determine
accurately the cause of death)
- sudden, unexpected or unexplained deaths related to diagnostic or
therapeutic procedures, including abortions
- deaths occurring in unusual places or under suspicious circumstances
- deaths occurring as the result of a suspected communicable disease or a
threat to public health
- deaths involving the possibility of neglect
- sudden deaths at the workplace
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