Department of Pathology

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Browsing Department of Pathology by browse.metadata.advisor "Burger, Elsie Helena"

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    Correlation of post mortem LODOX digital radiological images with histopathological findings at autopsy : a prospective autopsy study at the Tygerberg Forensic Pathology Service Facility
    (Stellenbosch : Stellenbosch University, 2015-04) Quarrie, Karisha Claudia; Burger, Elsie Helena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Forensic Medicine.
    ENGLISH ABSTRACT: Background: The LODOX Statscan is a whole-body digital X-ray scanning device which was adapted for medical usage. The LODOX has an established role in the field of Forensic Pathology where it shows high sensitivity and specificity for the detection of skeletal pathology and foreign bodies. The role of the scanner in the detection of soft tissue pathology in the lungs of adults has not been reported and this study aims to review the radio-pathological correlation and the applicability of LODOX as a viable screening tool in the detection of lung pathology in post mortem cases. Methods: We prospectively reviewed cases which were referred for medico-legal autopsy between November 2012 and March 2013 to the Tygerberg Forensic Pathology Service mortuary, Cape Town, South Africa. All cases meeting the prescribed inclusion criteria underwent LODOX scanning as well as macroscopic and microscopic evaluation of the lungs as permitted by the Inquests Act 58 of 1959. The macroscopic and microscopic variables were considered the “gold standard” when compared with the results of the LODOX. The sensitivity, specificity, positive and negative predictive values were assessed. Results: One hundred and fifty nine cases (159) were included in the study. The most common radiographic patterns reported were the presence of ground glass opacities and consolidation. Overall, low to moderate sensitivity of these LODOX patterns in the prediction of pneumonic microscopic pathology (oedema, acute and chronic inflammation and features of diffuse alveolar damage) was noted. These values were lower than that reported for pneumonia using conventional X-rays. Additionally, these LODOX patterns have a high probability of representing oedema or autolytic/decomposition change. Pneumothorax was the most common pleural pathology detected on LODOX, but autopsy correlation could not be performed. Poor to no correlation was noted with the variables of cavity, malignant tumour, and bronchiectasis, but the prevalence of these conditions in our cohort was low. In general, LODOX predictions were better at excluding pathology which was not present rather than confirming pathology which was present. Conclusions: The LODOX offers excellent evidentiary value in the demonstration of a pneumothorax but currently has limited value as a “stand alone” test in the field of Forensic Pathology. However the continued use of the LODOX as an adjunct examination, as well as prospective study of its applicability, is advised.
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    Sudden and unexpected deaths in adults : an investigation of cases reported to Tygerberg Forensic Pathology Services from January 2001 - December 2005
    (Stellenbosch : University of Stellenbosch, 2010-12) Tiemensma, Marianne; Burger, Elsie Helena; University of Stellenbosch. Faculty of Health Sciences. Dept. of Pathology. Forensic Medicine.
    ENGLISH ABSTRACT: Background - The workload of the forensic pathologist and Forensic Pathology Services staff is increased by the referral of potentially unnecessary natural cases to the Forensic Pathology Services. The primary aims of the medico-legal autopsy are limited to establishing a cause of death in presumed unnatural cases, and to exclude criminality or negligence. Objective – To determine the final outcomes of forensic post-mortem examinations in “sudden and unexpected” adult deaths over a 5 year period. Methods - An observational, retrospective, descriptive study was conducted. ”Sudden and unexpected” adult deaths referred to Tygerberg Forensic Pathology Services between 1 January 2001 and 31 December 2005 were reviewed. Data was collected from the autopsy reports, contemporaneous notes and hospital records. Findings – A total of 816 adult cases of sudden and unexpected death were referred to Tygerberg Forensic Pathology Services over the 5 year period studied. Complete autopsies had been performed in 74% (601/816) of cases. The presumed manner of death was natural in 79 % of cases, and an increase in the number of natural cases autopsied per year was noted over the 5-year study period. Diseases of the cardiovascular, respiratory and central nervous systems were responsible for the majority of natural deaths. Infectious diseases were responsible for most deaths in the youngest age group studied (18-29 years). Acute alcohol poisoning was responsible for the deaths of 35 (6%) cases, with an average blood alcohol concentration of 0.38g/100mL in these cases. Eight deaths were drug-/substance related. Waiting times for blood alcohol and toxicology results increased over the 5-year study period. No cause of death was found in 10.6% of cases. Conclusions -The questionnaire and interviewing structure could possibly be improved in order to obtain better pre-autopsy information and to reduce the number of “unnecessary” medicolegal autopsies, thereby reducing the burden of cost on the Forensic Pathology Services.