VIRTOPSY - the Swiss virtual autopsy approach

The aim of the VIRTOPSY project () is utilizing radiological scanning to push low-tech documentation and autopsy procedures in a world of high-tech medicine in order to improve scientific value, to increase significance and quality in the forensic field. The term VIRTOPSY was created from the terms virtual and autopsy: Virtual is derived from the Latin word 'virtus', which means 'useful, efficient and good'. Autopsy is a combination of the old Greek terms 'autos' (=self) and 'opsomei' (=I will see). Thus autopsy means 'to see with ones own eyes'. Because our goal was to eliminate the subjectivity of "autos", we merged the two terms virtual and autopsy - deleting "autos" - to create VIRTOPSY. Today the project VIRTOPSY combining the research topics under one scientific umbrella, is characterized by a trans-disciplinary research approach that combines Forensic Medicine, Pathology, Radiology, Image Processing, Physics, and Biomechanics to an international scientific network. The paper will give an overview of the Virtopsy change process in forensic medicine.

Inhalant deaths in South Australia: a 20-year retrospective autopsy study

A 20-year retrospective study of inhalant deaths in South Australia, autopsied at Forensic Science SA, was undertaken from January 1983 to December 2002. Thirty-nine cases were identified from an autopsy pool of 18,880 cases, with a male to female ratio of 12:1. Sixty-four percent of the victims (N = 25) died during voluntary inhalation of volatile substances and 28% (N = 11) committed suicide utilizing a volatile substance or gas. The remaining 3 cases involved a workplace accident (N = 1) and 2 cases of autoerotic death where inhalants were being used to augment solitary sexual activity. The mean age of the 28 victims of accidental inhalant death of 21 years (range, 13-45 years) was considerably less than that of the 11 suicide victims of 31.5 years (range, 17-48 years). No homicides were found. Approximately one quarter of the victims were Aboriginal (N = 11), 10 of whom had died as a result of gasoline inhalation ("petrol sniffing"). Other common substances of abuse were aliphatic hydrocarbons such as butane. The study has shown that those most at risk for accidental or suicidal inhalant deaths were young males, with 92% of victims overall being male, and with 77% of victims being under 31 years of age. Gasoline inhalation remains a significant problem in Aboriginal communities in South Australia.

Mechanisms of unexpected death and autopsy findings in Leigh syndrome (subacute necrotising encephalomyelopathy)

A 21-year-old previously-well woman who was undergoing medical investigations for problems with balance and suspected multiple sclerosis, developed a headache and breathing difficulties, and died suddenly and unexpected at home. The autopsy was unremarkable except for pulmonary and cerebral oedema. However, subsequent microscopy of the brain revealed characteristic features of Leigh syndrome with multifocal areas of astrogliosis, capillary proliferation, and parenchymal vacuolation. While Leigh syndrome is more commonly diagnosed in infancy, manifestations may occur throughout early life into adulthood. Sudden and unexpected death is a rare presentation that may be associated with cerebral necrosis and oedema. An awareness of the variable manifestations of Leigh syndrome is necessary in forensic practice as not all cases will present in a typical manner and sudden death may occur before a diagnosis has been established. The heritable nature of this condition makes accuracy of diagnosis essential.

Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)--a feasibility study

Using postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), 40 forensic cases were examined and findings were verified by subsequent autopsy. Results were classified as follows: (I) cause of death, (II) relevant traumatological and pathological findings, (III) vital reactions, (IV) reconstruction of injuries, (V) visualization. In these 40 forensic cases, 47 partly combined causes of death were diagnosed at autopsy, 26 (55%) causes of death were found independently using only radiological image data. Radiology was superior to autopsy in revealing certain cases of cranial, skeletal, or tissue trauma. Some forensic vital reactions were diagnosed equally well or better using MSCT/MRI. Radiological imaging techniques are particularly beneficial for reconstruction and visualization of forensic cases, including the opportunity to use the data for expert witness reports, teaching, quality control, and telemedical consultation. These preliminary results, based on the concept of "virtopsy," are promising enough to introduce and evaluate these radiological techniques in forensic medicine.

Postmortem imaging of blunt chest trauma using CT and MRI: comparison with autopsy

OBJECTIVE: Postmortem examination of chest trauma is an important domain in forensic medicine, which is today performed using autopsy. Since the implementation of cross-sectional imaging methods in forensic medicine such as computed tomography (CT) and magnetic resonance imaging (MRI), a number of advantages in comparison with autopsy have been described. Within the scope of validation of cross-sectional radiology in forensic medicine, the comparison of findings of postmortem imaging and autopsy in chest trauma was performed. METHODS: This retrospective study includes 24 cases with chest trauma that underwent postmortem CT, MRI, and autopsy. Two board-certified radiologists, blind to the autopsy findings, evaluated the radiologic data independently. Each radiologist interpreted postmortem CT and MRI data together for every case. The comparison of the results of the radiologic assessment with the autopsy and a calculation of interobserver discrepancy was performed. RESULTS: Using combined CT and MRI, between 75% and 100% of the investigated findings, except for hemomediastinum (70%), diaphragmatic ruptures (50%; n=2) and heart injury (38%), were discovered. Although the sensitivity and specificity regarding pneumomediastinum, pneumopericardium, and pericardial effusion were not calculated, as these findings were not mentioned at the autopsy, these findings were clearly seen radiologically. The averaged interobserver concordance was 90%. CONCLUSION: The sensitivity and specificity of our results demonstrate that postmortem CT and MRI are useful diagnostic methods for assessing chest trauma in forensic medicine as a supplement to autopsy. Further radiologic-pathologic case studies are necessary to define the role of postmortem CT and MRI as a single examination modality.

Abdominal trauma--sensitivity and specificity of postmortem noncontrast imaging findings compared with autopsy findings

The aim of the study was to determine the sensitivity and specificity for typical abdominal injuries after major blunt trauma in postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).

Sellar fracture followed by sudden death: an autopsy case

The authors describe a case of sellar fracture followed by sudden death. The victim was involved in a wrangle. The autopsy revealed facial damage and sellar fracture and no evidence of cerebral damage, except for a mild subarachnoid hemorrhage in the left parietotemporal regions and undersurface of both frontal lobes. Sellar fracture is a rare and severe entity, associated with serious complications, which is frequently diagnosed postmortem. In any case, death is rarely a direct consequence of the sellar fracture itself and is usually considered to be the result of associated cerebral trauma. This case prompted us to screen the literature on sellar fracture to gain a better understanding of the mechanism of death.

Standardized Performance Analysis (SPA) Summary for 1999-2000 Veterinary Medicine Students

Nine Iowa State University veterinary medical students completed SPA records on herds from Iowa, North Dakota and South Dakota. The Iowa herds were included in the SPA summary for Iowa, but the six North and South Dakota herds were summarized separately. These six herds had an average herd size of 371 cows and had a financial return to capital, labor and management of $175 per cow. Total financial cost per cow averaged $286 for these herds with a range of $211 to $388. Feed utilized averaged 4,442 pounds of dry matter per cow and the average pounds of calf produced per exposed female was 506 pounds.

Veterinary Medical Libraries in the 21st Century

The purpose of this volume is to present a picture of information access and delivery by United States and Canadian academic veterinary medical libraries (VMLs) to the veterinary community and others with interests in the profession. This is done by discussing the resources that are available, as well as methods of delivery of that information. Our discussion of these topics will not only point out the unique aspects of these collections and services, but will also illustrate much that is in common with all medical collections and library services. As with all libraries, the goal of VMLs is to provide high quality service while looking after the information needs of their clientele through selection, acquisition, cataloging, and dissemination of materials and familiarizing their users with these resources. In the past decade, new challenges and opportunities for information specialists stem from the impact of technology on VMLs. Our goal with this volume is to be concise, but thorough about all of these topics.

Prescription patterns of antimicrobials in veterinary practices in Switzerland

OBJECTIVES The objective of this study was to analyse antimicrobial prescriptions by veterinarians and to evaluate the appropriateness of use compared with prudent use guidelines. PRACTICES AND METHODS: Computerized records of prescriptions and treatments from eight mixed veterinary practices were analysed over a period of 2 years. A total of 61 212 antimicrobial treatments were recorded. Treatments were classified according to animal species treated, indication for treatment, route of administration and antimicrobial class used. For each treatment and antimicrobial substance, the prescribed dose was calculated. Dosage, antimicrobial classes and combinations of different classes used for different indications were compared with published recommendations. RESULTS From the total amount of 1590 kg of active antimicrobial substance, sulphonamides (594 kg), tetracyclines (335 kg), and penicillins and cephalosporins (290 kg) were the classes of which the largest quantity was prescribed. Penicillins and cephalosporins were most frequently prescribed (37% of treatments), followed by aminoglycosides (18%), tetracyclines (14%) and sulphonamides (11%). Sixty-one per cent of the amount of antimicrobials prescribed was used for the treatment of groups of animals via feed or water. Antimicrobial classes classified as highest priority for human medicine by an international group of experts were used in 9% of the prescriptions. The dosage corresponded to the manufacturer's recommendation in 45% of the analysed prescriptions. CONCLUSIONS Most prescriptions corresponded well to guidelines on prudent use of antimicrobials. Nevertheless, the large variation of prescriptions among different veterinarians indicates that the usage of critical antimicrobial substances and the amount of antimicrobials used for group medication without a specific indication could be further reduced.

Cardiac channel molecular autopsy: insights from 173 consecutive cases of autopsy-negative sudden unexplained death referred for postmortem genetic testing

OBJECTIVE To perform long QT syndrome and catecholaminergic polymorphic ventricular tachycardia cardiac channel postmortem genetic testing (molecular autopsy) for a large cohort of cases of autopsy-negative sudden unexplained death (SUD). METHODS From September 1, 1998, through October 31, 2010, 173 cases of SUD (106 males; mean ± SD age, 18.4 ± 12.9 years; age range, 1-69 years; 89% white) were referred by medical examiners or coroners for a cardiac channel molecular autopsy. Using polymerase chain reaction, denaturing high-performance liquid chromatography, and DNA sequencing, a comprehensive mutational analysis of the long QT syndrome susceptibility genes (KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2) and a targeted analysis of the catecholaminergic polymorphic ventricular tachycardia type 1-associated gene (RYR2) were conducted. RESULTS Overall, 45 putative pathogenic mutations absent in 400 to 700 controls were identified in 45 autopsy-negative SUD cases (26.0%). Females had a higher yield (26/67 [38.8%]) than males (19/106 [17.9%]; P<.005). Among SUD cases with exercise-induced death, the yield trended higher among the 1- to 10-year-olds (8/12 [66.7%]) compared with the 11- to 20-year-olds (4/27 [14.8%]; P=.002). In contrast, for those who died during a period of sleep, the 11- to 20-year-olds had a higher yield (9/25 [36.0%]) than the 1- to 10-year-olds (1/24 [4.2%]; P=.01). CONCLUSION Cardiac channel molecular autopsy should be considered in the evaluation of autopsy-negative SUD. Several interesting genotype-phenotype observations may provide insight into the expected yields of postmortem genetic testing for SUD and assist in selecting cases with the greatest potential for mutation discovery and directing genetic testing efforts.

Unexplained drownings and the cardiac channelopathies: a molecular autopsy series.

OBJECTIVE To determine the prevalence and spectrum of mutations associated with long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) in a seemingly unexplained drowning cohort. PATIENTS AND METHODS From September 1, 1998, through October 31, 2010, 35 unexplained drowning victims (23 male and 12 female; mean ± SD age, 17±12 years [range, 4-69 years]) were referred for a cardiac channel molecular autopsy. Of these, 28 (20 male and 8 female) drowned while swimming, and 7 (3 male and 4 female) were bathtub submersions. Polymerase chain reaction, denaturing high-performance liquid chromatography, and DNA sequencing were used for a comprehensive mutational analysis of the 3 major LQTS-susceptibility genes (KCNQ1, KCNH2, and SCN5A), and a targeted analysis of the CPVT1-associated, RYR2-encoded cardiac ryanodine receptor was conducted. RESULTS Of the 28 victims of swimming-related drowning, 8 (28.6%) were mutation positive, including 2 with KCNQ1 mutations (L273F, AAPdel71-73 plus V524G) and 6 with RYR2 mutations (R414C, I419F, R1013Q, V2321A, R2401H, and V2475F). None of the bathtub victims were mutation positive. Of the 28 victims who drowned while swimming, women were more likely to be mutation positive than men (5/8 [62.5%] vs 3/20 [15%]; P=.02). Although none of the mutation-positive, swimming-related drowning victims had a premortem diagnosis of LQTS or CPVT, a family history of cardiac arrest, family history of prior drowning, or QT prolongation was present in 50%. CONCLUSION Nearly 30% of the victims of swimming-related drowning hosted a cardiac channel mutation. Genetic testing should be considered in the postmortem evaluation of an unexplained drowning, especially if a positive personal or family history is elicited.