MinTankesmie

- Uten obduksjoner begraver sykhusene feilene sine

Without Autopsies, Hospitals Bury Their Mistakes (Uten obduksjoner begraver sykhusene feilene sine)
propublica.org 15.12.2011
When Renee Royak-Schaler unexpectedly collapsed and died on May 22, no one ordered an autopsy.

Not the doctors at Howard County General Hospital in Columbia, Md., where the 64-year-old professor and cancer researcher was pronounced dead.

In collaboration with the Investigative Reporting Program at the UC Berkeley Graduate School of Journalism

Not the Maryland Office of the Chief Medical Examiner, which passed on the case because no foul play was involved.

And not Royak-Schaler’s physicians at Johns Hopkins University School of Medicine who had diagnosed cancer in her hip two days beforehand but acknowledged they didn’t know what had caused her unforeseen death.

A half-century ago, an autopsy would have been routine. Autopsies, sometimes called the ultimate medical audit, were an integral part of American health care, performed on roughly half of all patients who died in hospitals. Today, data from the Centers for Disease Control and Prevention show, they are conducted on about 5 percent of such patients. (...)

(Anm: ProPublica (Journalism in the Public Interest). (mintankesmie.no).)

- Vil ha flere obduksjoner

Legen kan avgjøre organdonasjon
nrk.no 16.12.2011
– Vi tror det kan være et tungt ansvar å tvinges til å ta et standpunkt og vil derfor heller gi pårørende mulighet til å la legen ta en avgjørelse etter diskusjon med familien, sier utvalgsleder Hans Petter Aarseth.

Helsepersonell kan ta avgjørelsen om organdonasjon, foreslår det regjeringsoppnevnte transplantasjonsutvalget. (...)

Vil ha flere obduksjoner
Når det gjelder obduksjonsloven har utvalget foreslått en formålsparagraf, som sier hvorfor det er viktig å gjøre obduksjoner.

– Undersøkelser viser at når man foretar obduksjoner så finner man ofte ut at det ikke feilte pasienten det man først trodde. Og man kan finne at den behandlingen som ble gitt, ikke var riktig.

I dag foretas det, ifølge Aarseth, nesten ikke obduksjoner, noe som medfører at vi går glipp av de læringspunktene. Derfor må det tas noen grep for å få antall obduksjoner opp på et forsvarlig nivå, mener han.

Høringsutkastet går ut i januar. Deretter er det minimum tre måneders høringsfrist. (...)

- Obduksjoner avtar, unntatt på fjernsynet

Suicide Rates In England And Wales Might Be Wrong (Selvmordsrater i England og Wales kan være feilaktige)
medicalnewstoday.com 7.10.2011
Experts on bmj.com today warn that the increasing use of "narrative verdicts" made by coroners in England and Wales may lead to greater underestimation of suicide rates. The on-going research is partly funded by the National Institute for Health Research (NIHR).

In 2009 suicides accounted for 4,648 deaths in England and Wales. At present, official statistics produced by the Office for National Statistics (ONS) are based on open verdict deaths, also known as "short-from" verdicts, issued by coroners after inquests into unexpected or unnatural deaths.

According to Professor David Gunnell at the University of Bristol and his colleagues from the Universities of Oxford and Manchester there is a pressing need for changes to ensure that national suicide statistics will be reliable in the future.

Since 2001, increasing numbers of coroners have summarized inquest findings in several sentences by writing a "narrative verdict" that records how and in what circumstances death occurred rather than issuing a short form verdict and although narrative verdicts have some advantages, they often omit to mention intent. The authors say that the ONS can encounter problems in categorizing deaths with no clear intents and therefore classifies them as 'accidental'.

Between 2001 and 2009 the number of narrative verdicts increased from 111 to 3,012, which is more than 10% of all inquests, with figures for 2010 suggesting that the numbers continue to increase. (...)

Coroners’ verdicts and suicide statistics in England and Wales (Retssmedisineres avgjørelser og selvmordsstatistikk i England og Wales)
BMJ 2011; 343:d6030 (6 October)
Increasing use of narrative verdicts raises serious concerns (Økende bruk av beretninger som grunnlag for avgjørelser reiser alvorlige bekymringer)

Suicide is the most tragic consequence of mental illness, and it accounted for 4648 deaths in England and Wales in 2009.¹ Reliable suicide statistics are essential to inform and evaluate suicide prevention strategies,² highlight changes in rates (perhaps as a result of changing socioeconomic conditions), and detect emergence of new methods of suicide.³ (...)

Autopsies Waning, Except on Television (Obduksjoner avtar, unntatt på fjernsynet)
nytimes.com 3.10.2011
Autopsies are far more common on television than in real life. According to the National Center for Health Statistics, fewer than one in 10 deaths were followed by an autopsy in 2007, compared with one in five in 1972.

Autopsy Rates
Hospital autopsies are sometimes performed even when the cause of death is known — to determine the effect of therapy, for example, or to see whether there were other undiagnosed diseases that might have contributed to a death.

Normally, those autopsies would be authorized by the next of kin.

Forensic autopsies, on the other hand, are those that are required by law in cases of accident, assault, suicide or any other external event in which the cause of death could be relevant for legal purposes.

Of all autopsies in 1972, 79 percent of the deaths were caused by disease and 19 percent by accident, assault or suicide. For the remaining 2 percent, the cause was unknown.

By 2007, deaths from disease accounted for 46 percent of autopsies, while people who died of external causes accounted for 50 percent.

Of the 10 causes of death most likely to lead to an autopsy in 2007, the only one in the disease category was death in pregnancy or childbirth.

More than 60 percent of deaths in the 15-to-24 age group were autopsied in 2007, but the rate declined steadily with age. In the 65-to-74 group, only 4.2 percent of deaths were followed by an autopsy.

There are probably several reasons for the decline, according to the author of the report, Donna L. Hoyert, a health scientist with the National Center for Health Statistics. (...)

Suicide figures may be wrong, says study (Selvmordstall kan være feilaktige, ifølge studie)
austrianindependent.com 10.9.2011
Significantly more people may have killed themselves in Austria in the past years than official statistics suggest, according to a landmark investigation.

Researchers of Vienna Medical University (MedUni) said yesterday (Weds) they found out that a decrease of autopsies could distort figures on people’s causes of deaths. Fewer than one in five fatalities are examined in autopsies in Austria. Almost twice as many autopsies took place 20 years ago.

MedUni research found that countries with higher autopsy rates seem to have higher suicide figures. They pointed out that the number of suicides in these states could be understood to be higher purely based on the fact that more deceased citizens were found to have killed themselves as a higher number of autopsies took place.

The study considered cause of death information from 35 countries. It was published in Archives of General Psychiatry, a monthly medical journal of the American Medical Association.

Approximately 1,300 people killed themselves in Austria in the most recent years, according to official figures. Almost twice as many cases of suicide were recorded in the alpine country 25 years ago. At the same time, the number of autopsies dropped considerably. Especially the cause of death of elderly citizens is often not being investigated, the team of MedUni scientists pointed out. (...)

(Anm: Declining Autopsy Rates and Suicide Misclassification (Reduserte obduksjonsrater og feilklassifisering av selvmord) Arch Gen Psychiatry. 2011;68(10):1050-1057 (October) (pdf).)

Autopsy decline skews suicide rates (Redusert antall obduksjoner gir skjeve selvmordsrater)
imt.ie 3.8.2011
Caution should be used when comparing international suicide rates as many countries registering a decline in suicide show a corresponding drop in autopsies, international research shows.

The authors of the study concluded that autopsy rates were a “major predictor” for suicide rates, and “may [therefore] affect the validity of suicide statistics”.
The current analysis involved data from 35 European and Asian countries during a roughly 30-year period to 2007 and used autopsy rates as an external measure of validation of cause-of-death-statistics.

Writing in the Archives of General Psychiatry, the authors noted a consistently strong positive correlation between autopsy rates and suicide rates for all three decades of the study. For example, cross-sectional estimates showed that a 1 per cent difference between national autopsy rates was associated with a suicide rate difference of 0.49 per 100,000 population. (...)

Furthermore, declining suicide rates in Europe suggested these decreases harboured a “sizeable artifactual component” that warranted in-depth investigation. (...)

(Anm: Declining Autopsy Rates and Suicide Misclassification (Reduserte obduksjonsrater og feilklassifisering av selvmord) Arch Gen Psychiatry. 2011;68(10):1050-1057 (October) (pdf).)

Declining Autopsy Rates and Suicide Misclassification (pdf) (Reduserte obduksjonsrater og feilklassifisering av selvmord)
Arch Gen Psychiatry. 2011;68(10):1050-1057 (October)
Context Suicides are prone to misclassification during death ascertainment procedures. This problem has generated frequent criticism of the validity of suicide mortality statistics. (...)

Results Cross-sectionally, a 1% difference in autopsy rates among nations was associated with a suicide rate difference of 0.49 per 100 000 population. Longitudinally, a 1% decrease in the autopsy rate aligned with a decrease of 0.42 per 100 000 population in the suicide rate. These cross-sectional and longitudinal associations were robust after adjustment for unemployment, degree of urbanization, and prevalence of undetermined or ill-defined deaths. Associations strengthened when analyses were confined to 19 European Union member countries.

Conclusion Autopsy rates may spatially and temporally affect the validity of suicide mortality statistics. Caution should be exercised in comparing international suicide rates and evaluating interventions that target suicide rate reduction. (...)

NEW SUICIDE MISCLASSIFICATION HYPOTHESIS
Under the assumption that autopsies improve diagnostic accuracy of causes of death, ^{3, 17, 19} we adapted a hypothesis from Reseland et al¹⁶ that autopsy rates predict cross-national variation in suicide rates. We found a consistently strong positive cross-sectional correlation between autopsy rates and suicide rates for all 3 decades represented in our observation periods. Countries with high autopsy rates registered high suicide rates. Hungary, Austria, and 4 Baltic Sea countries (Estonia, Latvia, Lithuania, and Finland) are traditionally known as the countries with the highest suicide rates in Europe. Although some evaluations of the Finno-Ugrian suicide hypothesis propose a genetic link for the explanation of this geographic suicide cluster,³⁰ these countries also exhibit the highest autopsy rates. Our cross-sectional estimates showed that a 1% difference between national autopsy rates was associated with a suicide rate difference of 0.49 per 100 000 population. This estimate rose to 0.62 when we confined the analysis to our smaller EU sample. (...)

(Anm: Selvmord (mintankesmie.no).)

(Anm: Antidepressiva (SSRI-selvmord) (mintankesmie.no).)

- Obduksjonens betydning for registrering av dødsårsak

Obduksjonens betydning for registrering av dødsårsak
Tidsskr Nor Legeforen 2012; -1868:147-51
(...) Bakgrunn. Ved mer enn 90 % av dødsfallene i Norge er dødsmeldingen eneste informasjonskilde for registrering av underliggende dødsårsak. Ved bare en liten andel av tilfellene foreligger det tilleggsinformasjon, som regel fra sykehusobduksjon eller rettslig obduksjon. Vi ønsket å undersøke hvor hyppig funn ved sykehusobduksjon påvirker fastsettelsen av underliggende dødsårsak.

Materiale og metode. Med utgangspunkt i Dødsårsaksregisteret bestemte vi ut fra dødsmeldingen underliggende dødsårsak for dødsfall der det ble utført sykehusobduksjon i 2005. Deretter undersøkte vi om underliggende dødsårsak ble endret når vi tok hensyn til obduksjonsfunnene.

Resultater. I 2005 var det 41 152 dødsfall i Norge. Dødsårsaksregisteret mottok resultat av sykehusobduksjon for 1 773 døde, med alder fra to år og oppover. Obduksjonsfunn førte til endring av underliggende dødsårsak for 1 077 (61 %) dødsfall. For 567 dødsfall (32 %) var endringen stor og medførte skifte av ICD-10-kapittel for dødsårsaken. Andelen endrede dødsårsaker var større i de yngste og de eldste aldersgruppene og for kvinner.

Fortolkning. Sykehusobduksjon er et viktig korrektiv når det gjelder fastsetting av underliggende dødsårsak. (...)

- Dyrker organer i laboratorium

Dyrker organer i laboratorium
tv2nyhetene.no 1.11.2011
Ny teknologi kan redde livet til pasienter som trenger nye organer.

Mange pasienter venter på livreddende organdonasjon. Nå kan man ha funnet en annen løsning. Ved University College London har man utviklet en teknikk for å dyrke organer i laboratorier.

Lager avstøpning av det døde organet
Teknikere begynner med å lage en avstøpning av organet som må byttes ut. Denne avstøpningen dekkes med en ny type plastikk, som har mikroskopiske porer.
Stamceller fra pasientens kropp fester seg til porene på plastikken, og begynner å gro. Slik lar avstøpningen pasientens egne celler bygge et nytt organ.

Fordelen med dette er at man ikke risikerer at kroppen vil avvise det nye organet, noe som er en risiko ved organdonasjon.

Les også: Donorpasienter fikk kreftinfiserte nyrer

Et nytt luftrør på to til syv dager
Foreløpig har man bare foretatt én slik operasjon, hvor pasientens luftrør ble byttet ut. (...)

- Dårlig rettssikkerhet for pasienter

Døden på sykehuset:
Dårlig rettssikkerhet for pasienter
nrk.no 12.5.2011
De færreste som dør i såkalte uanturlige dødsfall i Norge blir obdusert.

Av de 372 unaturlige dødsfallene som ble meldt inn fra norske sykehus i fjor, ble mindre enn en tredel av dem obdusert av rettsmedisinere.

Hvert år dør flere tusen mennesker på norske sykehus. De fleste av naturlige grunner. Men mange dør også i såkalt unaturlige dødsfall.

Disse dødsfallene har skjedd uten at de var forventet, og i mange tilfeller uten at pasienten har vært igjennom en spesielt risikofylt behandling. Likevel blir de færreste obdusert av rettsmedisinere.

Se Brennpunkt-dokumentar i nett-tv: Døden på sykehuset (...)

Resurrect autopsies for the benefit of the living (Gjenoppta obduksjoner for nytten til de levende)
Short Cuts
BMJ 2008;336:530-531 (8 March)
N Engl J Med2008;358:873-5[Full Text]
Autopsies are dying out in the US. Fewer and fewer are done each year—even in the big teaching hospitals—and if the trend continues to its natural conclusion, doctors, patients, and the wider public will lose an important source of information about how and why people die, say two observers. Autopsies fine tune diagnoses and sometimes change them altogether. They help doctors improve their diagnostic skills and provide hospitals with an important tool for improving the quality and delivery of diagnostic imaging and laboratory services. It is also important for relatives to know that their father or brother died from an aortic dissection not a heart attack, one of the most common mistakes reported by autopsy studies .

Pathologists are losing interest in autopsies, new trainees are failing to learn the techniques, and quality is suffering. The lack of financial incentives for hospitals to perform autopsies hasn’t helped.

These experts say it is too late and too uneconomical to reverse the trend completely, but it may be possible to concentrate the necessary skills in regional centres. These hospitals could help maintain a service that benefits the living by improving the accuracy of death certificates, increasing the reliability of studies analysing causes of death, and teaching doctors where they have gone wrong. (...)

Autopsies Are Crucial Despite Concerns (Obduksjoner er avgjørende til tross for bekymringer)
medicalnewstoday.com 27.4.2007
Autopsies are vital for establishing causes of death, advancing medical research and training young doctors, despite religious, social and legal issues surrounding their use, claims a Review in this week's edition of The Lancet. (...)

The Review states that autopsies continue to reveal major pre-death diagnostic errors in around 30% of cases, and as such are vital for improving national mortality data on which health care strategies are based.

Dr Julian Burton and Professor Sir James Underwood, of The School of Medicine and Biomedical Sciences at The University of Sheffield, UK, studied the published views of doctors, pathologists, coroners and members of the public from around the world to establish whether the autopsy retains its importance in the 21st century.

They say: "Many doctors lack familiarity with autopsy practices, and are insufficiently aware of the benefits for not only bereaved families but also present and future patients." (...)

(Anm: Clinical, educational, and epidemiological value of autopsy. The Lancet 2007; 369:1471-1480.)

Færre obduksjoner bekymrer
nrk.no 20.3.2007
Risikoen for at drap og alvorlige voldssaker ikke oppdages øker fordi det blir utført færre obduksjoner i Nord-Norge. (...)

For noen år siden ble det gjort 3000 rettsmedisinske obduksjoner her i landet. I fjor var tallet sunket til 1740. (...)

I Nord Norge er tallene enda mer dramatisk. Mens det for 10 år siden bare på Universitetssykehuset i Nord-Norge ble utført rundt 150 rettsmedisinske obduksjoner, var tallet i fjor sunket til 61. (...)

Death of the autopsy
newscientist.com 14.11.2006
All doctors make mistakes. Worryingly, one of the surest ways to avoid repeating them is in steep decline (...)

Autopsies are dying out
timesonline.co.uk 14.11.2006 ()
CLINICIANS are no less fallible, but the number of autopsies is on the decline. In the 1960s, post-mortem examinations were performed on about 60 per cent of patients who died in hospital. The rate today is thought to be less than 10 per cent in Europe and less than 5 per cent in US hospitals, New Scientist (Nov 11) reports.

“It’s a big deal,” says Dr Kaveh Shojania, of the University of Ottawa. It is estimated that one hospital patient in 20 dies because his or her ailment was misdiagnosed. Half of such deaths are preventable, Dr Shojania says.

In one study, just 7 per cent of misdiagnoses were “no-fault errors” and yet the fall in the number of autopsies suggests that doctors and hospital administrators are not prepared to learn from their mistakes. But why? Clinicians don’t think it’s necessary any more,” Dr Shojania says. “It’s no longer part of training.” Others believe that doctors no longer request post-mortems for fear of litigation. Public healthcare systems are only too willing to concentrate limited resources elsewhere. (...)

Audits at University Hospitals of Leicester before and after the Alder Hey scandal indicate that the hospital autopsy rate had dropped from 10 per cent to less than 1 per cent. Not because relatives were refusing consent, but because doctors were less likely to ask. (...)

Autopsy quality concerns raised
bbc.co.uk 19.10.2006
The report says many coronial autopsies are below standard
A quarter of autopsies performed for coroners are of a poor or unacceptable standard, according to a report.

A study, asked for by the Royal College of Pathologists, examined 1,691 autopsies and found in 310 cases the cause of death given was questionable. (...)

The report called for better communication between coroners and pathologists and for standard procedures to be introduced.

Ian Martin, lead co-ordinator for NCEPOD, said: "Our hope is that the whole of the coronial system will be reviewed."

Mr Martin said a uniform system for the coronial autopsy procedure was needed.

"There needs to be clear instructions from the coroner to the pathologist that are written so they understand what the questions are from the coroner.

"A lack of communication leads to a poor standard of service for a large number of individuals who require autopsies."

NCEPOD REPORT

• One in four autopsy reports (436 of 1,691) judged as poor or unacceptable
• Brain was not examined in one in seven cases (238)
• Very elderly may not have been examined as carefully as younger subjects
• Only 64% (121 of 188) of mortuaries could store fixed tissues and organs

'True' cost

He said the current autopsy fee of £87.70 was undervalued, and placed pressure on pathologists.

"We don't know what the average cost of a coroner's post-mortem is, but one has to recognise that the current fee is inadequate," he said. (...)

(Anm: The Coroner’s Autopsy: Do we deserve better?
A report of the National Confi dential Enquiry into Patient Outcome and Death (2006) (PDF).)

(Anm: The NCEPOD 2006 Report: "The Coroner's Autopsy: Do we deserve better?" will be launched on Wednesday 18th October 2006 at the Royal College of Pathologists (Flier) (PDF)(18.10.2006).)

Poor-quality autopsies should cause public outcry, says report
guardian.co.uk 19.10.2006
• Quarter of all procedures found to be inadequate
• Many certificates give wrong cause of death

Many death certificates give the wrong cause of death, because of the poor or even unacceptable quality of a quarter of all autopsies, an inquiry reveals today. (...)

"The fact that there is no outcry is a manifestation of the fact that families are unaware of the variable quality of the autopsy procedure."

The inquiry team reviewed 1,691 autopsies performed during a single week in May 2005. They found that in a third of mortuaries, the pathologist did not necessarily examine the body for any external injuries before it was opened up by a technician and organs removed. In one in seven cases, the brain was not examined.

In nearly one in five cases, the cause of death stated was questionable. The investigators were particularly concerned about deaths in seven specific areas: cardiac enlargement, cancer, infection, alcohol, possible suicide, deaths shortly after surgery, and epilepsy.

The team also found poor recording of external injuries and poor communication between coroners and pathologists - there were sometimes significant gaps in the information provided by the coroner to the pathologist. There was also evidence that very elderly people may not have been as carefully examined as younger ones.

When the variable quality of autopsies was raised with pathologists and coroners, some commented: "What do you expect for £87.70?" - the current standard fee.

Ian Martin, lead clinician with the inquiry, said people would be shocked by the report. "I think it tells us that the system needs looking at in detail and there needs to be a debate about what we need out of it. If the public is paying for a system, they should know what they are getting for their money." (...)

Enquiry finds glaring faults in one in four autopsies
dailymail.co.uk 19.10.2006
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found evidence that elderly patients were not examined as closely as younger patients and that some autopsies were sped up. (...)

Hospitals ill-equipped to perform autopsies
hindu.com 17.10.2006 (Hindu - Chennai, India)
CHENNAI: Lack of infrastructure, staff shortage and poor remuneration have made it difficult to carry out autopsies in government hospitals, according to ...

"We do not have the tools nor are we given enough time to do a good job. What we do is just butchery," says an expert. Autopsies are done on request by the family or on the basis of a police inquest. "Usually it takes three hours to do an autopsy but we feel pressured to do it in 30 minutes. Otherwise, family members block roads." (...)

- Tenk på et tall!

Tenk på et tall!
LEDER - G C Alfsen
Tidsskr Nor Legeforen 2010; 130:1594 (26.8.2010)
Dårlig kvalitetssikring av data i norske helseregistre gir et usikkert grunnlag for helsepolitiske beslutninger og medisinsk overvåking av befolkningen (...)

Utsagnet «søppel inn gir søppel ut» mister ikke sin gyldighet ved at databasen blir tilgjengelig på nett. Sentralt i helseforskningen står Norsk pasientregister, et register der det ikke telles, men fortolkes. Data er basert på at legene tolker sykdomsforløpet objektivt og klarer å oversette dette til koder. (...)

Men sett utenfra gjør det faktum at valg av ICD-koder er medvirkende til sykehusenes økonomi, at Pasientregisteret må anses som et lærebokeksempel i mulig skjevfordelte data. (...)

Forgiftningsdødsfallene i Muan og kollegers arbeid ble bare unntaksvis bekreftet av obduksjon eller toksikologiske analyser. Her kan det skjule seg selvmord. Fallende selvmordsrater de siste årene har vært tilskrevet effekten av nye antidepressiver (7), men hvor sikre er disse data? Kurvene for antall selvmord og rettsmedisinske undersøkelser er påfallende parallelle (fig 1). Det er derfor nærliggende å anta at manglende melding og oppfølging av unaturlig død gjør at mange forgiftningsselvmord ikke lenger oppdages eller registreres. Sammenlikner man summen av selvmord med gift og akutte forgiftningsdødsfall for 1996 og 2008, finner man da heller ingen nedgang, men en økning på 29 %. Uten bedre kvalitetssikring av registertallene, kan vi altså ikke si at selvmordsratene faller. Med basis i offentlige registre kan man like gjerne hevde at økt salg av nye antidepressiver gir økende selvmordsrater! (...)

Figur 1 Selvmord, akutte forgiftninger og rettsmedisinske undersøkelser 1980–2008. Tall fra Statistisk sentralbyrå og Den norske patologforening. Rettsmedisinske undersøkelser er vist som tidel av originaltallene (...)

Kodepraksis ved forgiftningsdødsfall
Tidsskr Nor Legeforen 2010; 130:1601-5 (26.8.2010)
(...) Bakgrunn. Det er drøyt 10 000 sykehusinnleggelser og nesten 100 dødsfall årlig i norske sykehus grunnet akutt forgiftning med legemidler i supraterapeutiske doser og ikke-medisinske stoffer. Hensikten med denne studien har vært å evaluere sykehusenes kodepraksis ved akutte forgiftningsdødsfall og skaffe informasjon om forgiftningsagens. (...)

Fortolkning. Nåværende diagnosekodepraksis gir ikke et korrekt bilde av sykehusdødsfall ved akutte forgiftninger, og registerstudier basert på diagnosekoder bør tolkes med forsiktighet. Registrering av ATC-koder på forgiftningsagens er mangelfull, og den norske versjonen av ICD-10 alene er uegnet til klassifisering av medikamentelle forgiftninger. Man bør vurdere å innføre den internasjonale versjonen av ICD-10 eller bedre rutinene for bruk av ATC-koding. (...)

Alder og de fallende i obduksjonsrater

Age and the declining rate of autopsy (Alder og de fallende i obduksjonsrater)
J Am Geriatr Soc. 1986 Dec;34(12):865-8
To better understand declining autopsy rates, data have been gathered prospectively on 1080 consecutive deaths over six years among patients admitted to a medical intensive care/coronary care unit. Overall autopsy rate was 36%. Autopsy rates declined sharply with age from 60% for those aged 16 to 34 years to 23% for those 85 and over (P less than .001). The highest rates by diagnosis were aortic aneurysm (70%), hepatic failure (52%), heart rhythm disturbance (48%), pulmonary embolism (45%), and sepsis (41%). Patients receiving major procedures had a significantly higher autopsy rate (38 versus 29%, P less than .05) but rates bore little relation to prognoses given at admission by house officers, suddenness of death, sex, marital status or year of admission. Even among intensively treated patients, autopsy rates decline strikingly with age, demanding honest re-appraisal to restore the place of autopsy in medical education, clinical research, and quality of care assessment for an increasingly elderly population. (...)

Bør obduksjoner standardiseres?

U.S. Won't Standardize Autopsies of 9/11 Workers
washingtonpost.com 19.11.2006
-- The federal government has abandoned an effort to create standard autopsy guidelines that could document a link between toxic air at Ground Zero and deaths of rescue workers, citing concerns that the data could be misinterpreted.

The chief medical officer for the city Fire Department said one of the study's "insurmountable barriers" included the possibility that the information could be used in civil lawsuits by lawyers and others with an "undeniable self-interest" in the cause of death.

The National Institute for Occupational Safety and Health, in a note posted Friday on its Web site, said the agency "instead will pursue other avenues for documenting long-term health effects from exposure to air contaminants from the World Trade Center disaster."

Outside medical experts who reviewed the original plan had raised several questions, the institute said, including concerns that "the draft document could be misinterpreted or misapplied, hindering rather than furthering progress in addressing WTC health concerns." (...)

- Mangler penger til obduksjon

Hospitals ill-equipped to perform autopsies
hindu.com 17.10.2006
Poor payment, lack of staff and infrastructure cited as reasons Lack of staff, infrastructure cited as reasons

CHENNAI: Lack of infrastructure, staff shortage and poor remuneration have made it difficult to carry out autopsies in government hospitals, according to forensic science experts.

"We do not have the tools nor are we given enough time to do a good job. What we do is just butchery," says an expert. Autopsies are done on request by the family or on the basis of a police inquest. "Usually it takes three hours to do an autopsy but we feel pressured to do it in 30 minutes. Otherwise, family members block roads."

Government hospitals in the city and even the lone private teaching medical college hospital authorised to do autopsies are not equipped to handle the bodies brought to their morgues. (...)

Frykter feildiagnoser
aftenposten.no 14.9.2006
Sikkerheten for pasienter som behandles på sykehus med få obduksjoner er svekket, mener Den Norske Patologiforening. (...)

I 1985 foretok sykehusene i Norge 6273 obduksjoner. I 2004 var dette tallet nede i 2900. (...)

Statssekretær i Helse - og omsorgsdepartementet, Wegard Harsvik, sier obduksjon brukes der det er nødvendig.

- Obduksjon skal gjennomføres når det av særlige grunner er nødvendig å få fastslått dødsårsaken eller når det er behov for obduksjon av hensyn til forskning, undervisning og kvalitetssikring av pasientbehandlingen, sier Harsvik. (...)

Tjener ikke på obduksjon
Alfsen peker på tre årsaker til at sykehusene ikke prioriterer å obdusere dødsfall.
- For det første tjener ikke sykehusene noe på obduksjon. Det er en ren utgiftspost. Videre er det en underbemanning av antall patologer på sykehusene. Til slutt er det et av og til manglende påtrykk fra legene i forhold til å sende lik til obduksjon, sier Alfsen.

Hun mener løsningen på problemet er mer penger.
- Sykehus må få penger per obduksjon. Det vil gjøre det mer attraktivt for det enkelte sykehus å øke obduksjonstallet. Dette har forøvrig vært foreslått flere ganger overfor myndighetene, både fra patologer og Helsetilsyn, men uten at noe har skjedd.

Vil ikke få mere penger
Helse- og omsorgsdepartementet sier de regionale helseforetakene får basistilskudd som skal dekke forskning og undervisning på det enkelte sykehus. Foreløpig må disse midlene også dekke utgifter til obduksjoner.

- Vi er opptatt av høy at helsetjenesten skal holde høy kvalitet og følger utviklingen. Men Helse- og omsorgsdepartementet har per i dag ikke planer om å innføre en ordning hvor sykehusene får penger for hver obduksjon de utfører, sier Harsvik.

Ifølge rettsmedisiner på Universitetet i Oslo, Torleiv Ole Rognum, er det de mindre sykehusene som i dag utfører færrest obduksjoner, men også mange av universitetssykehusene har mer enn halvvert obduksjonene de siste årene.
(...)

- Fikk aldri vite dødsårsaken

- Fikk aldri vite dødsårsaken
aftenposten.no 14.9.2006
(...) I dødsattesten konkluderte kommunelegen som var til stede påskeaften med: "antatt dødsårsak overdose, kan vurderes videre". (...)

Ifølge politiadvokat i Agder politidistriktt, Beate Rullestad Jansen, ble Bjørn Håkon ikke obdusert fordi det var klare indikasjoner på at det var et overdosedødsfall. Hun vil ikke konkretisere hva disse indikasjonene består i.

Kommunelegen som var på plass hos Bjørn Håkon påskeaften, ønsker ikke å uttale seg om den konkrete saken, men sier det generelt kan være vanskelig å få utført obduksjoner i fylket.

- Min erfaring generelt er at det er vanskelig å få utført en obduksjon selv om dødsårsaken er ukjent. Det er på grunn av ressursmangel, sier Kåre Dale, kommunelege i Iveland kommune.

Det var også ressursmangel politiet skyldte på da Ragnhild Blickfeldt ringte dem for å be om en obduksjon dagene før sønnen ble kremert.

"Her har du kommet til en konkursbedrift som så mange andre" var, ifølge Blickfeldt Jørgensen, svaret moren fikk av påtaleansvarlig ved politivakten i Agder politidistrikt.

Tanja Blickfeldt Jørgensen er oppgitt over at pårørende skal måtte være nødt til å kjempe så hardt for å få vite dødsårsaken.

- Dette burde være en menneskerett, sier Jørgensen.

Har du opplevd noe lignende? Send e-post til Aftenpostens reporter (...)

Færre obduksjoner svekker rettssikkerhet

Daniel Smith's Pictorial Postmortem?
eonline.com 30.1.2008
If only these pictures could speak for themselves. (...)

The Bahamian pathologist who performed Daniel's official autopsy, Dr. Govinda Raju, told the court last month that the young man had at least eight different drugs in his system when he died, although he reaffirmed that it was a combination of Zoloft, Lexapro and prescription methadone that killed him. (...)

 

Pathologist Ready To Testify If Needed
jonesbahamas.com 27.11.2006
Celebrity pathologist Dr. Cyril Wecht has insisted that he has no hesitation about participating in an inquest into the sudden death of 20-year-old Daniel Smith, the son of embattled American celebrity Vicky Lynn Hogan, alias Anna Nicole Smith. (...)

Imidlertid insisterer dr. Wecht fortsatt på at den unge mannens død var et uhell. (Dr. Wecht, however, continues to insist that the young man’s death was accidental.)

"There’s no way in the world that anybody could – in my opinion – consider this to be a homicide or a suicide…It’s an accident. The manner of death is accidental, a tragic, tragic accident, and it’s something that is not at all rare," he insisted. (...)

Suicides present investigative challenges (Selvmordsundersøkelser byr på utfordringer)
chicoer.com 26.11.2006
(...) Suicides pose special problems for coroner investigators because it's not always clear whether the individual died intentionally or accidentally. The death may actually be a murder in disguise. The scene of death could be set up in such a way as to appear to be an accident or a self-inflicted death, when it is really neither. (...)

In some cases, a definitive ruling of the cause of death can't be made. That happened in a case involving an overdose of the drug Fentanyl. Jones said the death appeared to be deliberate, but the evidence wasn't conclusive. The death was officially ruled "undetermined." (...)

Anna Nicole Smith Fails To Attend Son's Funeral
In Texas...
entertainmentwise.com 9.10.2006
Family and friends of Daniel Wayne Smith, the young son of Anna Nicole Smith celebrated his life in Texas over the weekend. (...)

Etter to obduksjoner ble det endelig oppdaget at Daniel Wayne døde av en cocktail av legemidler i kroppen. (After two post-mortems it was finally discovered that Daniel Wayne had died due to a cocktail of drugs in his system.)

Toxicology reports founds that Daniel Wayne had taken a concoction of methadone, Zoloft and Lexapro that caused cardiac dysrhythmia leading to his sudden death. (...)

Krever flere obduksjoner
aftenposten.no 15.9.2006
- Vi kan ikke diskutere kroner og øre og la drapsmenn gå fri, sier Frp-topp.

Det er justispolitisk talsmann i Frp, Jan Arild Ellingsen, som tordner mot det han mener er justisminister Knut Storbergets handlingslammelse i forhold til å få økt antallet rettsmedisinske obduksjoner.

Han reagerer på at Regjeringen ikke gjennomfører det Stortinget har bedt dem om.

I dag er antallet rettsmedisinske obduksjoner så lavt at det går utover rettssikkerheten til folk, mener både Ellingsen og rettsmedisinere Aftenposten.no har pratet med. (...)

- Flere obduksjoner vil avdekke nye drap
Aftenposten 26.10.2005
Hvert år begås det drap i Norge som aldri oppdages fordi den døde ikke blir obdusert. Det mener professor i rettsmedisin Åshild Vege ved NTNU i Trondheim.

Drapsstatistikken til Nye Kripos viser at det ble begått 31 drap i Norge i fjor. Det reelle antall drap kan være høyere, mener rettsmedisineren.

- Ifølge svenske statistikker oppdages det årlig ett drap per 1.000 rettsmedisinske obduksjoner der drap ikke var mistenkt på forhånd. Sammenligner vi den svenske undersøkelsen med norske forhold, er det grunn til å anta at det årlig begås ett til to drap her til lands som ikke oppdages, sier Vege til Adresseavisen.

Statens helsetilsyn anbefaler obduksjon av 40 prosent av dem som dør. De siste årene er det kun gjennomført obduksjon ved 10-12 prosent av dødsfallene i Norge.

- For få lik til obduksjon
Aftenposten 9.9.2005
- En rekke drapsmenn blir aldri avslørt fordi politiet sender for få lik til obduksjon, sier professor Sidsel Rogde ved Rettsmedisinsk Institutt.

Nå ber Politiets Fellesforbund justisministeren ta affære.

Tidlig på 1990-tallet ble antallet obduksjoner ved Rettsmedisinsk Institutt halvert fra 1600 til 800 årlig. Årsaken var at politiet da fikk beskjed om å betale for obduksjonene og politimestrene ba drapsjegerne om å spare penger. Senere steg antallet obduksjoner litt til 1000-1100. Halvparten av Norges befolkning bor i de politidistrikter instituttet betjener.

- Årlig avsløres minst to drap ved obduksjon. Men vi mener enda flere drap ville blitt oppdaget om politiet hadde sendt oss flere lik, noe de dropper av økonomiske årsaker, sier professor Rogde. Hun nevner som eksempel en narkoman politiet trodde var død av en overdose. Obduksjonen konkluderte med at han var drept av vold mot hodet.

Rogde sier de mottar færre obduksjoner jo lenger unna Oslo likene skal sendes. Hun mener transportutgiftene teller med. Det faktum at færre lik obduseres, mener hun har en negativ betydning utover at drapsmenn går fri.

-En kvinne ringte meg overbevist om at et familiemedlem var drept av skuddskader. Politiet hadde en annen oppfatning og sendte ikke liket til obduksjon. Det er beklagelig. For henne som mange andre pårørende er det viktig å få et riktig svar, sier Rogde. (...)

New Autopsy Report Says Abused Prescription Drug Overdoses Tops Illegal Drugs (Ny obduksjonsrapport viser at overdoser av reseptbelagte legemidler overgår overdoser av illegale midler)
allheadlinenews.com 6.11.2006
Tallahassee, FL (AHN) - According to the Florida Department of Law Enforcement, the medical examiners office released its 6-month report for the period from January through June 2006. In Florida, there were approximately 89,000 deaths during this timeframe, and 3,595 of these deaths were attributable to one or more drugs found during the autopsies.

The report indicates that several prescription drugs were found in overdoses more than the illegal drugs. (...)

USA: Utilsiktede legemiddelforgiftninger står nå for nesten like mange dødsfall som bilulykker

 

Prescription-related fatalities skyrocket (Forskrivningsrelaterte dødsfall øker kraftig)
seattlepi.nwsource.com 5.2.2007
SPOKANE -- Deaths in Washington linked to prescription drugs such as hydrocodone and methadone increased by more than 800 percent in 10 years, according to new research. (...)

Utilsiktede legemiddelforgiftninger står nå for nesten like mange dødsfall som bilulykker -- omtrent 640 per år -- primært på grunn av forskrivningsrelaterte dødsfall, sa Jennifer Sabel, som er epidemiologist ved det statlige Health Department. (Unintended drug poisonings now account for almost as many deaths in Washington as car crashes -- about 650 a year -- primarily because of the spike in prescription-related fatalities, said Jennifer Sabel, an epidemiologist with the state Health Department.)

"Prescription drug overdose deaths have been climbing through the roof," Sabel said. "Even doctors don't really realize the magnitude of the deaths." (...)

Overdoser og årsakssammenheng (tilsiktet versus utilsiktet (intentional versus unintentional)

Deaths related to Prescription Drug Overdoses Continue to Rise
georgia.gov 21.7.2011
DECATUR –An analysis of autopsies performed by the GBI Medical Examiner’s Office in 152 counties which drug overdose was the cause of deathor a significant contributing factor in the death found there was a 10% increase in the number of prescription overdose deaths in 2010 compared to 2009.　

Note: These statistics do NOTinclude autopsies performed by medical examiners in Fulton, Cobb, Gwinnett, DeKalb, Henry, Hall or Rockdale Counties.

Of the 729 drug overdose deaths in 2010, there were 560 deaths which involved only prescription drugs.　 The analysis also showed that 101 drug overdose deaths in 2010 involved only illicit drugs and sixty-eight (68) deaths were attributed to a combination of both prescription and illicit drugs.

In 2009, 508 of the 670 overdose deaths were attributed to prescription drugs only.(...)

Forgiftningsdødsfall utenfor sykehus
Ole B. Hovind Tidsskr
Nor Lægeforen 2007; 127: 1005 (19.4.2007)
I dette nummer av Tidsskriftet presenteres det tall om sykelighet og dødelighet ved akutte forgiftninger. Alkoholforgiftninger dominerer, men tallene for narkotikadødsfall utenfor sykehus er skremmende. Hvor mange av disse som skyldes uhell og hvor mange som er tilsiktet, er usikkert. (...)

Årlig ble det registrert omkring 500 dødsfall etter akutt forgiftning

Akutte forgiftninger 1999 - 2004 - sykelighet og dødelighet
Grethe Helen Bøe Lilleeng Knut Joachim Berg Finn Gjertsen Erik Andrew
Tidsskr Nor Lægeforen 2007; 127: 1023-7 (19.4.2007)
(...) Resultater. I perioden 1999 - 2004 var det årlig nesten 11 000 utskrivninger etter heldøgnsopphold ved somatiske sykehus som var relatert til akutt forgiftning (hoved- og bitilstand). Mortaliteten i sykehus var 0,8 %. Årlig ble det registrert omkring 500 dødsfall etter akutt forgiftning. Omkring 80 % av forgiftningsdødsfallene fant sted utenfor sykehus. (...)

En annen svakhet er at vi ikke vet hvor mange personer som ble behandlet etter akutt forgiftning. (...)

Selv om inntak av legemidler utgjorde 73 % av sykehusforgiftningene, manglet det informasjon om type legemiddel. Dette viser hvor mangelfull nåværende informasjon om legemiddelforgiftninger er i Norsk pasientregister. (...)

Fortolkning. Resultatene tyder på økt sykelighet og stabil dødelighet etter akutte forgiftninger i Norge. Informasjonen i dødsårsaksregisteret og spesielt i pasientregisteret bør forbedres. Spesifisering av agens og bruk av ATC-koder ved legemiddelforgiftninger vil øke nytteverdien. (...)

Konklusjon
I denne undersøkelsen presenteres for første gang en nasjonal oversikt over sykelighet og dødelighet etter akutt forgiftning. Rundt 500 personer døde årlig av akutt forgiftning, derav ca. 90 i sykehus. Det betyr at 80 % av dødsfallene fant sted utenfor sykehus. Årlig var bortimot 11 000 utskrivninger etter heldøgnsopphold ved somatiske sykehus relatert til akutt forgiftning som hoved- eller bitilstand. (...)

- Trender for selvmord og utilsiktede forgiftningsdødsfall

Suicide and unintentional poisoning mortality trends in the United States, 1987-2006: two unrelated phenomena? (Trender for selvmord og utilsiktede forgiftningsdødsfall i USA 1987-2006; to ikke-relaterte fenomen?)
BMC Public Health. 2010;10:705 (Nov 17)
BACKGROUND: Two counter trends in injury mortality have been separately reported in the US in recent times - a declining suicide rate and a rapidly rising unintentional poisoning mortality rate. Poisoning suicides are especially difficult to detect, and injury of undetermined intent is the underlying cause-of-death category most likely to reflect this difficulty. We compare suicide and poisoning mortality trends over two decades in a preliminary assessment of their independence and implications for suicide misclassification. (...)

CONCLUSIONS: The official decline in the suicide rate between 1987 and 2000 may have been a partial artifact of misclassification of non-elderly suicides within unintentional poisoning mortality. We recommend in-depth national, regional, and local population-based research investigations of the poisoning-suicide nexus, and endorse calls for widening the scope of the definition of suicide and evaluation of its risk factors. (...)

Unintentional Poisoning Deaths United States 1999-2004 (Utilsiktede forgiftningsdødsfall i USA 1999-2004)
JAMA. 2007;297:1309-1311 (March 28)
MMWR. 2007;56:93-96
(...) I 2004 var forgiftninger i USA, som årsak til utilsiktede skader, nummer to etter bilulykker.¹ Nesten alle forgiftningsdødsfall i USA tilskrives medikamenter, og de fleste forgiftninger skjer som resultat av misbruk av reseptbelagte legemidler eller illegale midler.² (...) (In 2004, poisoning was second only to motor-vehicle crashes as a cause of death from unintentional injury in the United States.¹ Nearly all poisoning deaths in the United States are attributed to drugs, and most drug poisonings result from the abuse of prescription and illegal drugs.²)

Antallet utilsiktede forgiftningsdødsfall økte fra 12 186 i 1999 til 20 950 i 2004. Den årlige aldersjusterte rate økte med 62,5 %, fra 4,4 per 100 000 mennesker i 1999 til 7,1 i 2004. Økningen blant kvinner, fra 2,3 til 4,7 per 100,000 mennesker (103,0 %), var en dobling i forhold til økningen blant menn, fra 6,5 til 9,5 per 100,000 mennesker (47,1 %) (Table 1). (...) (The number of unintentional poisoning deaths increased from 12,186 in 1999 to 20,950 in 2004. The annual age-adjusted rate increased 62.5%, from 4.4 per 100,000 population in 1999 to 7.1 in 2004. The increase among females, from 2.3 to 4.7 per 100,000 population (103.0%), was twice the increase among males, from 6.5 to 9.5 per 100,000 population (47.1%) (Table 1).

Girl's Overdose Death Raises Questions
washingtonpost.com 23.3.2007
HULL, Mass. -- In the final months of Rebecca Riley's life, a school nurse said the little girl was so weak she was like a "floppy doll." The preschool principal had to help Rebecca off the bus because the 4-year-old was shaking so badly. And a pharmacist complained that Rebecca's mother kept coming up with excuses for why her daughter needed more and more medication. None of their concerns was enough to save Rebecca. (...)

Recent trends in mortality from unintentional injury in the United States
Journal of Safety Research 2006;37(3):277-283
Introduction: Recent observations suggest that the unintentional injury mortality rate may be increasing in the United States for the first time since 1979. Method: This study examined trends in unintentional injury mortality by sex, race, mechanism, and age group to better understand these increases. Results: From 1992 to 2002, mortality increased 11.0% (6.5% for males, 18.5% for females). The mortality rate increased 16.5% among whites, but declined among African Americans and other races. Rates among whites exceeded rates among African Americans for the first time since 1998. Fall rates increased 39.5% from 1992 to 2002, and poisoning rates increased 121.5%. Motor-vehicle rates did not increase overall. Rates in age groups from 40–64 years of age increased for falls, poisoning, and motor-vehicle crashes. Only fall rates increased for the 65+ age group. Conclusions: These results raise the issue of whether these increases have one or more risk factors in common, such as recent increases in the use of alcohol and prescription drugs. (...)

Overdosed: Poor health of Tennesseans, cultural expectations contribute to high prescription use
timesnews.net 17.2.2007
There is an epidemic in the Volunteer State, and if you don't believe it, take a look at the long lines at the prescription counter of your neighborhood pharmacy. (...)

Earlier this month, the national Centers for Disease Control and Prevention said drug interactions are the second-leading cause of accidental deaths nationwide. Auto accidents are the first.

In 2004, there were more than 19,800 deaths nationwide from unintentional drug interactions. (...)

Thoughts of suicide more common in today's youth
clantonadvertiser.com 17.2.2007
(...) After such a loss, Brown found herself alone. She said that between the ages of 11 and 14 she attempted suicide at least four times. Three involved trying to overdose with pills and one involved locking herself up in a garage with the car running. (...)

Grand Jury Issues Indictment In Drug Overdose Case
mdcoastdispatch.com 7.12.2006
– A local man who allegedly contributed to the death of a 22-year-old woman who died from a drug overdose last October was indicted by the county’s grand jury last week, and could face murder charges if further autopsy results determine she succumbed solely from substances he provided her, police say. (...)

Suicides present investigative challenges (Selvmordsundersøkelser byr på utfordringer)
chicoer.com 26.11.2006
(...) Suicides pose special problems for coroner investigators because it's not always clear whether the individual died intentionally or accidentally. The death may actually be a murder in disguise. The scene of death could be set up in such a way as to appear to be an accident or a self-inflicted death, when it is really neither. (...)

In some cases, a definitive ruling of the cause of death can't be made. That happened in a case involving an overdose of the drug Fentanyl. Jones said the death appeared to be deliberate, but the evidence wasn't conclusive. The death was officially ruled "undetermined." (...)

Selvpåført forgiftning gir dårlige prognoser

Selvpåført forgiftning gir dårlige prognoser
ulleval.no 7.2.2007
Ullevål og andre sykehus i Oslo får inn nærmere 1000 pasienter hvert år med selvpåført forgiftning. Noen har gjort et selvmordsforsøk. Andre har fått i seg for mye alkohol, narkotika, medikamenter eller andre giftige substanser. Pasienter med selvpåført forgiftning har dårlig prognose på lang sikt, viser ny forskning gjort ved Ullevål universitetssykehus. (...)

Høy dødelighet
Undersøkelsen viser at personer som ble lagt inn på grunn av selvpåført forgiftning for 20 år siden, har en langt høyere dødelighet enn befolkningen for øvrig. Nesten 40 prosent av pasientene var døde 20 år etter, til tross for at gjennomsnittsalderen kun var 31 år da de hadde en akutt forgiftning.

– Dette er en gruppe pasienter som ikke får så mye av helsevesenets ressurser, til tross for at de har svært alvorlige helseproblemer. Forskningsresultatene tyder på at pasienter med selvpåført forgiftning bør få økt oppfølging, i hvert fall hvis vi skal følge prinsippet om at alvorlige helseproblemer skal ha mer ressurser enn mindre alvorlige helseproblemer, sier Asphjell Bjørnaas.

Flere stoffer
Pasienter som komme inn til akuttmottaket med selvpåført forgiftning er ofte i koma, eller lite villige til å fortelle om eget inntak av illegale rusmidler. Noen er også ambivalente i forhold til et ønske om å dø. I alle tilfeller kan legene få vanskeligheter med å finne ut hvilke stoffer pasienten har inntatt. Noen ganger må legene gi behandling kun på bakgrunn av mistanke.
Asphjell Bjørnaas har undersøkt i hvilken grad det er samsvar mellom legens mistanker når pasienten kommer til akuttmottaket, og hvilke stoffer som faktisk er å finne i pasientenes blod og urin. Analyser i laboratorier viser at pasientene ofte hadde tatt flere stoffer enn det legene mistenkte i starten. (...)

"There is no such thing as suicide by accident," he said.

Anna Nicole døde av overdose
vg.no 26.3.2007
(VG Nett) Politietterforskningen konkluderer med at Anna Nicole Smith døde av en overdose hun har inntatt selv. (...)

På pressekonferansen kom det frem at Smith brukte både anti-depressive tabletter, smertestillende og slankemiddel. (...)

Perper -- Death Definitely Not Suicide, Not a Homicide
tmz.com 26.3.2007
Anna Nicole Smith was recovering from her depression at the time of her death, but she had not made statements about suicide in the weeks prior to her death.

Dr. Joshua Perper says Anna did not try to commit suicide when she fell in a pool shortly after Daniel died. It was an accident caused by too many drugs. (...)

Officials: Accidental overdose caused Smith's death
cnn.com 26.3.2007
FORT LAUDERDALE, Florida (CNN) -- A drug overdose killed former reality TV star and Playboy playmate Anna Nicole Smith, Seminole Police Chief Charlie Tiger said Monday.

Tiger said there was no evidence of foul play and the overdose was accidental. (...)

UPDATE: The Anna Nicole Autopsy Report
etonline.com 21.3.2007
While Dr. Perper said he would not speculate as to suicide or any other rumored cause of death, such as pneumonia or a possible drug overdose, he made it clear he would not determine the cause of death as an accidental suicide.

"There is no such thing as suicide by accident," he said. "In order for the manner of death to be suicidal, it has to be the intention of the person to take their own life." (...)

Kvalitet på diagnostisering av unaturlige dødstall

- Vil avdekke flere drap
aftenposten.no 20.11.2006
Unaturlige dødsfall som obduseres vil trolig dobles de neste årene. Bjørn (...)

Fakta om obduksjon:
• Rundt en prosent (ca 45 000) av Norges befolkning dør hvert år.
• Rundt 10 prosent av alle dødsfallene regnes som unaturlige dødsfall (se egen faktaboks om unaturlige dødsfall)
• I 1989 ble 3000 av disse obdusert. I dag er tallet nede i 1700
• Svensk statistikk viser at bak 1000 unaturlige dødsfall som obduseres, skjuler seg ett til to drap som man antok å ikke være drap i utgangspunktet.
• I 2004 ble åtte prosent av alle dødsfall i Oslo obdusert. Tilsvarende tall i Agder var bare en prosent. (...)

Fakta om unaturlige dødsfall:
I følge Helsepersonelloven eksisterer det ni kriterier for et unaturlig dødsfall:
• Drap eller annen legemskrenkelse
• Selvmord eller selvvoldt skade
• Ulykke som forlis, brann, skred, lynnedslag, drukning, fall eller trafikkulykke
• Yrkesulykke eller yrkesskade
• Feil, forsømmelse eller uhell ved undersøkelse eller behandling av sykdom eller skade.
• Misbruk av narkotika
• Ukjent årsak når døden har inntrådt plutselig og uventet
• Dødsfall i fengsel eller under sivil eller militær arrest
• Funn av ukjent lik. (...)

Vil obduksjoner bli finansiert sentralt i framtiden?
Vi har fått sterke føringer både fra Stortinget og fra direktoratet om å endre finansieringsordningen, så det sier jo sitt, sier statssekretær i justisdepartementet, Terje Moland Pedersen.
Når vil det bli en endring?
- For justisministeren er dette en prioritert sak, sier Pedersen. (...)

Making deaths count
Bulletin of the World Health Organization (BLT) 2006;84(3):161-256
Death has always been an overriding concern: two of the Millennium Development Goals express targets in terms of mortality and one out of three components of the Human Development Index is a mortality measure. It is therefore surprising that the systematic measurement of mortality is relatively recent: rudimentary life tables to summarize mortality from the 17th century, the use of systematically collected data on vital events to examine mortality differentials and cause of death from the 19th century, and systematic explorations of behavioural risk factors only in the 20th. Today, routinely collected data on vital events provide complete and representative information for only about 40% of the world’s countries and a quarter of its population (1). (...)

- Alle døde barn må granskes

- Alle døde barn må granskes
aftenposten.no 7.5.2006
Barneombudet og rettsmedisiner mener tiden er overmoden for en kommisjon som gransker alle uventede og plutselige barnedødsfall. Det kan avsløre barnemordere.

- I en rettsstat som Norge burde en kommisjon som undersøker uventede og plutselige barnedødsfall, være opplagt. Men da er vi nødt til å undersøke alle under 18 år, sier professor Torleiv Ole Rognum ved Rikshospitalet.

- Når voksne dør uventet og plutselig, blir politiet varslet. Men ved spedbarnsdød har politiet instruks om å avvente obduksjon før de eventuelt gjør noe. Da er det ofte for sent, sier Rognum.

Rundt 50 barn i Norge under tre år dør uventet og plutselig hvert år. Det er ikke så ofte at barn mellom fire og 18 år dør på denne måten. Rognum anslår at knapt halvparten av de 50 dør i krybbedød.

To-tre barn blir utsatt for drap. Ett barn dør som følge av mishandling. Fem-seks barn blir rammet av omsorgssvikt med dødelig utgang. 14 dør av sykdom, fem dør av ulykker, en som følge av medisinsk feilbehandling. (...)

Selvmord hos barn underrapportert

Child suicide rates under-reported (Selvmord hos barn underrapportert)
news.com.au 2.11.2006
The Commission for Children and Young People and Child Guardian today released its annual report into causes of child deaths in Queensland for the past year. (...)

The report also raised serious concerns about under-reporting of suicides, saying children's suicides were often grouped into other death categories.

The report said many children's suicides were recorded as accidents by the Coroners Office, while the registry of Births, Deaths and Marriages was restricted by law from recording the word suicide as a cause of death for children. (...)

(Anm: Commission for Children and Young People 2005-06 - Annual reports released:

Commission for Children and Young People 2005-06

Child Death Case Review Committee 2005-06

Deaths of children and young people Queensland 2005-06 (...)

Likhusfest

Ingen sparket etter likhusfest
vg.no 3.2.2006
FREDRIKSTAD (VG Nett) Alle som var med på festen rundt obduksjonsbenken på likhuset ved Sykehuset Østfold Fredrikstad, beholder jobbene. (...)

Alle som var med på festen får beholde jobbene, og den mest alvorlige "reaksjonen" mot enkeltdeltakere er skriftlig advarsel, opplyser sykehusledelsen.

Det var en fredagskveld i desember i fjor at noen sykehusansatte hadde vorspiel rundt obduksjonsbenken vegg i vegg med Sykehuset Østfolds likkjeller.

Administrerende direktør Ulf Ljungblad beklager igjen at en slik hendelse har rammet sykehuset.

- Sykehuset Østfold vil derfor fortsette arbeidet med tiltak knyttet til holdninger, verdier og retningslinjer, sier han.

Stålbenken som til daglig brukes til obduksjon av døde mennesker, skal ha vært pyntet med et hvitt laken til duk under vorspielet. På «bordet» hadde festdeltagerne ølflasker og levende lys. Senere på kvelden gikk de på julebord.

De var et titall ansatte ved sykehusets avdeling for transport og sikkerhet, samt enkelte andre sykehusansatte som brukte obduksjonssalen som festbule.

Organtyverier

Tandlæge stjal organer fra TV -legendes lig
bt.dk 26.2.2006
Alistair Cooke - også han lig skulle være blevet udsat for organtyveri. Foto: Getty Images

En skrækhistorie ruller i øjeblikket hen over New York. Mere end 1000 lig er blevet skrællet for organer, som derefter er blevet videresolgt. BBC- og TV-legenden Alistair Cooke skulle være et af ofrene. De fjernede organer blev erstattet med afløbsrør. Fire er anholdt.

Da TV-legenden Alistair Cooke døde i New York for to år siden, var der mange som vemodigt fældede en tåre. Men mange af hans fans verden over vil nok blive chokeret, når det kommer frem, at hans lig også skulle have været udsat for organ-røvernes ivrige fingre.

Det mener i hvert fald den offentlige anklager i Brooklyn, Charles Hynes, der chokerede den store millionbefolkning i New York, da han via diverse aviser...

...og TV-kanaler natten mellem fredag og lørdag kunne berette om sagen.
Fire mand blev anholdt i sagen fredag. Hovedmand er den tidligere tandlæge Michael Mastromarino. Derudover er hans tre hjælpere, Lee Crucetta, Joseph Nicelli og Christopher Aldorasi også pågrebet, skriver New York Post.

- Vi mener, at det i alt drejer sig om 1077 lig, siger Charles Hynes, der betegner sagen som værre end i en billig skrækfilm. De fire tiltales for ulovlig gravåbning, tyveri af lig, ulovlig dissekering og ulovlig salg af organer. De pårørende har alle været uvidende om, hvad der er foregået.

Hovedmanden, Michael Mastromarino er tandlæge, men mistede sin offentlige licens for fem år siden, uden at man vil komme ind på årsagen. Og herefter skulle han ifølge anklagemyndigheden have startet sit makabre arbejde.
Politiet vil heller ikke fortælle de nærmere omstændigheder, hvordan de fire arbejdede - og fik fat i de mange lig. Men flere er givetvis stjålet fra hospitaler, lighuse, ligesom der er forfalsket donationspapirer.

De friske lig er blevet skrællet for forskellige organer, og i stedet har man fyldt plast-affaldsrør ind i de tomme huller. Organerne er så hurtigt derefter solgt på det sorte marked. I flere tilfælde har man ifølge anklageren gjort donoren betydelig yngre end tilfældet var.

Politiet er nu gået i gang med at spore de mange lig, som er blevet plyndret for organer og skeletdele. Herefter går man i gang med sagen mod de fire mænd, der alle står til langvarige fængselsstraffe.

Et felles, hurtigarbeidende utvalg

Skal fastsette krav til rettsmedisinerne
Aftenposten 12.9.2005
Etter en uke med krass kritikk fra rettsmedisinske eksperter nedsetter Politidirektoratet, Kripos og Riksadvokaten nå et felles, hurtigarbeidende utvalg. (...)

Alarmen gikk tidligere denne uken da eksperter på Rettsmedisinsk institutt fortalte at politiet snur på krona og sender for få lik til obduksjon og at plutselige barnedødsfall undersøkes for dårlig. De mener mange drap dermed aldri blir avslørt. Lederen for Politiets Fellesforbund, Arne Johannessen, ber justisminister Odd Einar Dørum ta affære.

Kommersiell DNA-analyse?

Rapport bestilt av Storberget: Mener DNA-monopol truer rettssikkerheten
aftenposten.no 2.11.2011
Ventetid på DNA-analyse har gått kraftig ned

I en rapport om bruken av DNA-bevis i Norge, mener forskerne at man må oppheve monopolet på DNA-analyse for å trygge rettssikkerheten

De siste dagene har Aftenposten skrevet flere saker om DNA-bevis knyttet opp mot alle overfallsvoldtektene i Oslo. Høyre har foreslått at private – i realiteten DNA-laboratoriet Gena i Stavanger – skal få lov til å analysere DNA-prøver i kriminalsaker, fordi det blant annet har vært lang ventetid ved Rettsmedisinsk institutt i Oslo. Gena hevder de kan gjøre ting kjappere enn Rettsmedisinsk institutt i Oslo kan gjøre. Men det vil ikke regjeringen fordi de ikke vil «kommersialisere virksomheten».

Les også: Privat DNA-lab vil la seg kjøpe av Staten

Rapporten «Sakkyndighet ved bruk av DNA-bevis» har førsteamanuensis i rettsvitenskap, Ragna Aarli, skrevet sammen med jusprofessor Asbjørn Strandbakken og peker på mange kritiske forhold ved bruken av DNA-bevis i Norge - blant annet problemer med monopol på DNA-analyse.

Ragna Aarli, førsteamanuensis ved Universitetet i Bergen, som er en av de to som har skrevet rapporten vil ikke ta stilling i privat/offentlig-debatten, men er krystallklar på at Rettsmedisinsk institutt ikke bør ha monopol på DNA-analyse i kriminalsaker. (...)

Frykter kommersiell DNA-analyse
Aftenposten 6.9.2005
Universitetet i Oslo vil overlate Rettsmedisinsk Institutt til Rikshospitalet. Politiforbundets leder Arne Johannessen mener kommersiell drift betyr fare for rettssikkerheten. (...)

Universitetet har bistått politiet med rettsmedisinere i kriminalsaker siden opprettelsen i 1938. Nå kan ordningen opphøre, både ansatte og ledelse reagerer kraftig. Universitetets styre skal avgjøre saken 11. oktober.

- Dette er en prinsipielt viktig sak som krever en politisk avgjørelse. Rikshospitalet er et helseforetak og styres av inntjening. Dette kommer i konflikt med grunnleggende prinsipper knyttet til rettssikkerheten, mener Politiets Fellesforbunds leder, Arne Johannessen. (...)

Årlig foretar instituttet 900-1000 rettslige obduksjoner, i tillegg til et stadig økende antall DNA-analyser i kriminalsaker. Antallet DNA-analyser vil øke kraftig dersom Norge endrer lovverket i tråd med andre nordiske land.

- Dette må skje uavhengig av kommersielle interesser. Her må justisminister Odd Einar Dørum på banen. Også politidirektøren og andre faginstanser må signalisere sitt syn, sier Johannessen.

Han får følge av leder på Rettsmedisinsk Institutt, Brita Teige, som sier det er viktig at saken bringes opp på politisk nivå. Hun ønsker en prinsippdebatt om hvorledes de rettsmedisinske tjenester skal organiseres og finansieres.

Shipman-saken

Chairwoman of Shipman inquiry protests at lack of action
BMJ 2006;332:1111 (13 May)
The government, the General Medical Council, and the medical profession were criticised last week for failing to respond to the recommendations of the inquiry into the case of Harold Shipman, the GP who murdered more than 200 patients.
At a meeting convened at the Royal Society of Medicine in London to discuss trust between doctors and patients after the Shipman case, Janet Smith, chairwoman of the Shipman inquiry, said that the case had "disclosed a raft of flaws in professional governance" and that "inaction cannot be defended." (...)

Progress 'too slow' after Shipman
bbc.co.uk 2.5.2006
Ministers have been attacked for not acting on some recommendations of the inquiry into the Shipman murders.

Inquiry chairman Dame Janet Smith said she had been disappointed by the lack of progress over drug controls and checks on doctors' competence.

Her criticisms came as the impact of the killings on the doctor-patient relationship was discussed in London.

The former GP was found guilty of murdering 15 patients, but the true figure is thought to be 250.

Speaking at a Royal Society of Medicine conference in London, she criticised the government for failing so far to implement many of her recommendations. (...)

There are doctors who still think that everything is fine and that there is no need for change. There are still those who think Shipman was a one-off villain. (Dame Janet Smith, chairman of Shipman inquiry) (...)

GMC clears doctors who signed cremation forms for Shipman
BMJ 2005;331:126 (16 July)
Four GPs who signed the cremation forms of patients murdered by serial killer Harold Shipman have been cleared of serious professional misconduct by the General Medical Council.

The four GPs were accused of failing to notice coincidences between the pattern of Shipman's home visits and the deaths of his patients (BMJ 2005;331: 68[ Free Full Text ], 9 July). But the GMC panel, sitting in Manchester, accepted the doctors' arguments that they could not have been reasonably expected to account for behaviour as extraordinary as Dr Shipman's.

GPs appear before GMC accused of missing warning signs in deaths of Shipman's patients
BMJ 2005;331:68 (9 July)
Alastair MacGillivray, Jeremy Dirckze, Stephen Farrar, and Susan Booth, all of Hyde, Greater Manchester, are accused of neglecting to use proper clinical judgment in confirming the cause of death when signing a total of 214 cremation forms over a period of 18 years. Of these 214 patients 124 were later found to have been unlawfully killed.
The Shipman inquiry led by Janet Smith criticised six Hyde GPs and a pathologist for failing to note contradictions in Dr Shipman's accounts of his patients' deaths. The pathologist, David Bee, and two of the GPs, Peter Bennett and Rajesh Patel, were cleared by the GMC last year.

Sixth doctor cleared over Shipman
bbc 8.7.2005
Harold Shipman murdered about 250 patients with morphine
A sixth doctor who signed cremation forms for serial killer Harold Shipman in Greater Manchester has been cleared of professional misconduct.

Dr Susan Booth was found not guilty of serious professional misconduct by the General Medical Council on Friday.

Shipman is thought to have murdered about 250 people with lethal morphine injections between 1975 and 1998.

He was jailed for life in January 2000 after being convicted of 15 counts of murder at Preston Crown Court, and was found hanged in his Wakefield prison cell four years later.

Virtuell obduksjon (bildediagnostikk)

Can Imaging Help Revive the Autopsy?
JAMA. 2012;307(14):1471-1472 (April 11)
Half a century ago, autopsies were routinely performed on about 50% of all patients who died in hospitals. Not only a powerful tool for quality improvement in patient care, the autopsy generates accurate vital statistics, provides a better understanding of diseases, helps in the detection of new infections, and drives progress in medicine. (...)

Imaging is no substitute for autopsy
BMJ 2011;343:d7693 (30 November)

All you need to read in the other general journals
Lancet2011; doi:10.1016/S0140-6736(11)61483-9
Radiological imaging after death is a poor substitute for a full autopsy, say researchers, who did both in an unselected series of 182 cases and compared the findings. Radiology reports disagreed with findings from a full autopsy in about a third of cases, although computed tomography alone looked more reliable than magnetic resonance imaging alone (proportion with major discrepancies 32% (95% CI 26% to 40%) v 43% (36% to 50%)).

Postmortem imaging missed all 10 cases of pulmonary embolus, nine of 28 cases of bronchopneumonia, four of six intestinal infarctions, and 12 of 86 deaths from coronary heart disease. Imaging overdiagnosed coronary heart disease too (15/95). (...)

Magnetkamera räcker inte för att fastställa dödsorsak
dagensmedicin.se 21.11.2011
Rutinmässig bilddiagnostik kan ännu inte ersätta traditionella obduktioner.

Den slutsatsen drar brittiska forskare efter att ha undersökt hur tillförlitlig datortomografi respektive magnetkamerateknik är för att fastställa dödsorsaken hos avlidna som skickats för obduktion.

I studien i tidskriften Lancet kommer de fram till att man med hjälp av sådan teknik kan fånga dödsorsaken i två av tre fall.

Men tekniken behöver utvecklas - i dag missar den ofta vanliga orsaker till plötslig död, enligt forskarna.

De tittade närmare på 182 vuxna avlidna som tagits till obduktion. Samtliga undersöktes med både datortomografi och magnetkamera innan de obducerades.

Resultaten visar att datortomografi var mer tillförlitligt än magnetkameraundersökning för att identifiera dödsorsaken.

Dödsfall på grund av kranskärlssjukdom, lungembolism och lunginflammation hörde till dem där bilddiagnostiken oftast inte räckte till.

Forskarna drar slutsatsen att datortomografi och magnetkamera ännu inte kan ersätta traditionella obduktioner.

Bakom studien står bland andra forskare vid John Radcliff Hospital i Oxford, Storbritannien. (...)

Will CT Scans and MRIs Kill the Autopsy? (Vil CT-skanninger og MRI erstatte obduksjoner)
blogs.scientificamerican.com 21.11.2011
Instead of cutting into a dead body to determine the cause of death, some coroners are already calling in a radiologist. But can CT (computed tomography) and MRI (magnetic-resonance imaging) tests accurately assess the recently deceased?

Formal autopsies have been on the decline for decades, due in part to tightening budgets. In the U.S. less than a quarter of deaths are followed with an autopsy, and previous research has shown that about a third of deaths have an incorrect causes listed on the death certificate. To lower cost and to help families whose religions prohibit post-mortem dissection, non-invasive imaging technology has been gaining favor. Some evidence had suggested, however, that CTs and MRIs are not quite as reliable as a traditional autopsy.

A new U.K. study of 182 adult deaths shows that more than half the time, a radiologist could pinpoint the cause of death with just a scan. But in 42 percent of CT scans and 32 percent of MRIs (and 30 percent of cases that used both), the radiologists’ assessments differed from those from a full autopsy. The research was led by Ian Roberts, of the cellular pathology department at John Radcliffe Hospital in Oxford, and the results were published online Monday in The Lancet.

“Post-mortem imaging cannot yet be regarded as a universal substitute for autopsy,” James Underwood, of the University of Sheffield, wrote in an essay in the same issue of the journal.

Imaging analyses were particularly poor at picking up certain common causes of death, including artery blockage (pulmonary embolism) and pneumonia. But they surpassed autopsy in a few areas, such as collapsed lungs and some bone fractures. Another benefit would be their longevity, remaining available for re-analysis long after tissue samples would have been discarded. (...)

(Anm: Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet, Early Online Publication, 22 November).)

Virtual autopsy: Inside the skull of a suicide victim
newscientist.com 20.2.2009
Video: See the virtual autopsy
Many people hate the idea of a loved one being dissected – even if it could provide vital clues about how and why they died. But it may not be necessary for much longer. A growing number of countries, including the UK, Australia, US, and Japan, are looking towards virtual autopsies as an alternative to opening the bodies of people who die in suspicious circumstances.

By combining surface scans of the body with CT and MRI scans, it is possible to work out what happened to a person without cutting them open. A small biopsy of tissue is also taken to measure cellular structure and to check for the presence of drugs. (...)

Divining Death's Cause
usnews.com 3.9.2006
Pathologists are embracing new no-touch "virtual autopsies," with 3-D images that reveal valuable clues

The mysterious death of a 3-week-old Swedish infant in early 2004 could have been an episode of CSI. The baby girl died while a defect in her vocal cords was being examined with a laryngoscope, and an autopsy failed to explain her death. But finely detailed 3-D images from a "virtual autopsy"-a CT scan performed prior to the usual kind-held the answer. The images showed a tiny perforation in the baby's voice box where a needle on the laryngoscope had gone astray. Air had rushed into her chest, collapsing her left lung. As doctors tried to relieve the pressure on the lung, the needle punctured the sac around her heart. Air leaked in. Her heart stopped.

The Pentagon has employed this emerging technology since late 2004 on the remains of military members in Iraq and Afghanistan, to determine how helmets and body armor can better protect against bullets and bombs. Forensic investigators in Sweden and Switzerland have put virtual autopsy to use in cases such as the one above, and specialists are flocking to conferences in Australia and Europe to learn the technique. Medical examiners in the United States are also beginning to show interest. A new mortuary for the Maryland medical examiner is slated to include the ability to perform virtual autopsies. (...)

Autopsy comeback? The technology's boosters think it also might substitute, if not perfectly, for hospital autopsies, which have all but disappeared. One reason for the dive in autopsy rates from about 50 percent in the 1960s to an average of 5 percent now is that since 1970, hospitals no longer have to perform a minimum rate of autopsies to remain accredited. Another is physicians' widespread belief that autopsies tell them nothing about diagnosing and treating patients that sophisticated monitoring, imaging, and lab tests don't provide. And at a cost of several thousand dollars per autopsy, few hospitals are eager to do lots of them. (...)

Skanning av lik avløser obduksjon
illvit.com 2005(7);32-35
Tapet av et familiemedlem er ofte så stort at de etterlatte motsetter seg obduksjon, som kan fastslå dødsårsaken. Tanken på et oppskåret lik er rett og slett for skremmende. Men nå er virtuell obduksjon på vei, og i den inngår det verken skalpell eller blod. (...)

Anatomy of an autopsy

Coroner Alice Carlson Jackson offers an...
Anatomy of an autopsy
madisoncourier.com 10.8.2007
Alice Carlson Jackson likes to read murder mysteries, and she has seen the rawest kinds of death in person at autopsies both as a student and as the Jefferson County coroner. But she was taken aback when she took a rare surfing venture on the Internet to prepare for a presentation Thursday night at the library.

She found that she - and anybody else - can watch autopsies online.

"I was shocked," Jackson said. "I was pretty appalled."

Thanks to television shows like "CSI," the public isn't as squeamish about autopsies as it used to be, she told an audience of 14. (...)

CT, MRI Scans Offer New Tools for Autopsy

CT, MRI Scans Offer New Tools for Autopsy
JAMA. 2007;298:392-393
The latest versions of imaging devices could play a part in autopsy, but costs may ultimately limit their acceptance in the general health care community.
Pathologists have traditionally used x-ray imaging before autopsy to focus their explorations. But lately researchers have published findings suggesting that "virtual autopsy" using multidetector computed tomography (MSCT) or magnetic resonance imaging (MRI) may be an even better tool to help determine death. (...)

But offering words of caution to the acceptance of virtual autopsy is Geoffrey Rubin, MD, a professor of radiology at the Stanford University School of Medicine, Stanford, California. "For the vast majority of causes of death, I do not have a lot of confidence in using imaging to see them because so much of our imaging depends on the body being given a contrast agent which requires circulating blood—something that doesn't happen in people who are dead," Rubin said.

Even if imaging does not replace traditional autopsy, it could augment these dissections, said Joseph A. Prahlow, MD, president of the National Association of Medical Examiners. He cited especially the need to look at the deep structures of the neck and to identify subtle injuries. "While we can do that at autopsy, having the ability to look at it before we take out the bone saws can be very helpful," said Prahlow, a forensic pathologist and associate professor of pathology at Indiana University School of Medicine's South Bend Center. (...)

Obduksjonsrater i USA

Evidence Report/Technology Assessment: Number 58 (pdf)
Autopsy as an Outcome and Performance Measure
ahrq.gov (October 2002)
(...) Overview
An extensive literature documents a high prevalence of errors in clinical diagnosis discovered at autopsy. Multiple studies have suggested no significant decrease in these errors over time. Despite these findings, autopsies have dramatically decreased in frequency in the United States and many other countries.

In 1994, the last year for which national U.S. data exist, the autopsy rate for all non-forensic deaths fell below 6 percent. The marked decline in autopsy rates from previous rates of 40-50 percent undoubtedly reflects various factors, including reimbursement issues, the attitudes of clinicians regarding the utility of autopsies in the setting of other diagnostic advances, and general unfamiliarity with the autopsy and techniques for requesting it, especially among physicians-in-training. (…)

Using the regression model to compute rates of autopsydetected diagnostic errors over a range of autopsy rates and as a function of time, contemporary (year 2000) autopsies detect Class I errors in 3.8-7.9% of cases and major errors in 8.0-22.8%, of cases. These ranges reflect variations in autopsy rates from 5-100%. (…)

Temporal and geographic trends in the autopsy frequency of blunt and penetrating trauma deaths in the United States
JAMA 269; No. 12, March 24, 1993
(...) RESULTS--The autopsy frequency of blunt and penetrating trauma deaths in the United States increased by 14.3% during the 1980s to 58.9% in 1989 (62,004 of 105,309 deaths autopsied), while the autopsy frequency of all deaths decreased by 23.6% during the same period to 11.5% in 1989 (248,272 of 2,153,859 deaths autopsied). (...)

Virtual Autopsy: Supporting Clinical Practice And National Policy
November, 2004
By Richard M. Satava, MD, FACS

Richard M. Satava, MD FACS Professor of Surgery University of Washington Medical Center Seattle, Wash.

Autopsy is the ultimate scientific tool to determine cause of death. Yet this procedure has been unchanged for thousands of years. True, newer forensic diagnostic tools have been added to glean more information from the material that is obtained from autopsy, however the autopsy procedure itself remains the same. (...)

But less than nine per cent of people dying in the hospital will have an autopsy1 to determine cause of death or ancillary medical conditions that could have contributed to the demise or be medically relevant for the family or relatives. In fact, in 1995 the National Center for Health Statistics stopped collecting autopsy statistics, even while the disturbing trend over the past 30 years has been a continuously declining autopsy rate.2 It would be unfair to state that 91 per cent of our data on cause of death and incidence of disease is speculation, yet it is clear that the majority of documentation is based upon clinical impression that frequently has not been supported by definitive scientific evidence. While it is true that much of the clinical documentation is accurate, there are few who would not welcome the final confirmation of an autopsy. Many barriers exist to accomplishing an autopsy on every death (universal autopsy), such as reluctance by the physician to request from the family, religious preferences or prohibitions, family hesitancy at a time of grief, etc. The result is that many unanswered questions remain and the final diagnoses often are truly a best guess. (…)

Notes
1) www.uihealthcare.com/news/currents/vol2issue3/6autopsy.html

2) Hanzlick R. National autopsy data dropped from the National Center for Health Statistics Database. JAMA. 1998 Sep 9;280(10):886.

3) Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, Schroth G, Ith M, Sonnenschein M, Doernhoefer T, Scheurer E, Plattner T, Dirnhofer R. Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)-a feasibility study. Forensic Sci. 2003 Mar;48(2):386-403.

Richard M. Satava, MD, FACS, is a Professor of Surgery at the University of Washington Medical Center, and Program Manager for Advanced Biomedical Technologies at Defense Advanced Research Projects Agency (DARPA), and a Special Assistant in Advanced Surgical Technologies at the U.S. Army Medical Research and Materiel Command in Fort Detrick, Md. He can be reached at rsatava@u.washington.edu. Dr. Satava will contribute columns to U.S. MEDICINE periodically.

The decline of the autopsy
Zlatko Anguelov (in collaboration with Richard Lynch, M.D., and Michael Cohen, M.D.)
Currents: Summer 2001, Volume 2, Number 3

History: To err is human, and medicine has always been the art of dealing with uncertainties. For centuries, this double postulate justified the autopsy as the best way to find out the cause of death and the concomitant diseases in the deceased patient. Furthermore, the autopsy was used to help uncover the pathogenesis of disease and better understand disease processes.
In modern terms, the autopsy is a quality control of the practice of medicine. It clearly establishes the extent of the disease and the effect of administered treatments, or lack thereof, and thus confirms or dismisses the clinical management of the case. However, the autopsy is not a verdict but a tool for learning and adjustment. Unexpected findings at autopsy are an excellent way to gain knowledge and refine clinical judgment.

Historically, clinical-pathologic/morbidity-and-mortality conferences (M&MC) have been used as a valuable add-on to the autopsy. Usually held weekly, these conferences have represented a standardized case report system to analyze the reasons for adverse outcomes of care. A recent national survey on the value of the M&MC found that 43% of residents and 47% of surgical faculty believed it was a powerful educational tool.

New facts: Nationally, autopsy rates have declined from 50% in the 1940s to a discouraging 14% in 1985. Autopsy rates in non-teaching hospitals are now less than 9%. Moreover, fewer autopsy reports reach clinicians in a timely way, which, along with the concomitant decline in M&MC, inevitably reduces the educational value of the autopsy and downplays its role as a tool for professional improvement. In 1995, the National Center for Health Statistics even stopped collecting autopsy data altogether. (...)

Cost is another argument against performing an autopsy. Autopsy is covered only by Medicare, and pathologists in non-teaching hospitals prefer to spend time in clinical labs where they can make more money. In addition, there is the fear of litigation. Autopsy is a way to find medical errors, and in today's litigious environment, it's easy for a family to sue for damages based on evidence collected by autopsy. Finally, some people in the profession argue that since autopsies have failed to significantly reduce error and improve care, they are no longer useful.

In order to maintain an adequate autopsy rate, physicians should request autopsies. (...)

National Autopsy Data Dropped From the National Center for Health Statistics Database
JAMA 1998;280 (September 9)
To the Editor.—Because of imposed budget reductions, the National Center for Health Statistics (NCHS) in 1995 ceased to collect the item indicating whether an autopsy was performed (item 28a reported on the US Standard Certificate of Death) for its national mortality statistical database.1 The NCHS purchases mortality data from the states and pays each state for data based in part on the state's calculated cost of data entry (keystrokes). Thus, eliminating the purchase of specific data items from states is one way to reduce NCHS's expenses. (...)

Panel Finds Fault With Florida autopsies

Panel Finds Fault With Florida autopsies
guardian.co.uk 10.8.2006
JUPITER, Fla. (AP) - The medical examiner who performed a disputed autopsy on a teenager who died at a boot camp for juvenile offenders was negligent in performing at least 35 of nearly 700 autopsies reviewed, state officials said Wednesday.

The Florida Medical Examiners Commission recommended that Dr. Charles Siebert be placed on supervised probation for the remaining 10 months of his contract in Bay County in the Florida Panhandle.

A panel of commission members reviewed 698 autopsies dating to August 2003 and found that Siebert had sometimes failed ``to perform the duties required of a medical examiner.'' (...)

Alder Hey Children's Hospital, Liverpool, UK

Autopsy at the crossroads
The Lancet 2006; 367:1460
The retained organs affair at Alder Hey Children's Hospital, Liverpool, UK, demonised pathologists (a report into the hospital came out in early 2001). The episode made it more difficult to obtain consent for an autopsy from bereaved and anxious relatives. Next came the setting up of the Human Tissue Authority (HTA) under the Human Tissue Act 2004 in the UK. In September this year, the Authority will require establishments to be licensed to do autopsies, and to remove and store tissues. To do these procedures without a licence will be unlawful.

Last January, the HTA published a code of practice for postmortem examinations when a hospital has consent from the deceased or their relatives or at a coroner's request. Autopsies can only be done in licensed premises. Although removal and storage of tissue might seem usual practice in an autopsy, specific consent must be obtained for these procedures.

The introduction of such regulation, in part designed to allay public suspicion about autopsies and tissue removal, was inevitable after the Alder Hey incident. The current situation in the UK can be chaotic, with many concerned relatives refusing consent for an autopsy even when one is needed to determine a cause of death or confirm a diagnosis. Some consent to a part autopsy, when permission to examine specific body regions (eg, cranium, thorax) is withheld, which is hardly the point of doing the examination in the first place. (...)

Autopsy uproar not M.E.'s first

Autopsy uproar not M.E.'s first
miami.com 21.2.2006
A medical examiner involved in a boot camp death autopsy allowed his license to lapse and once signed a mistake-prone autopsy saying a woman had male genitalia.

Effect of media portrayals of removal of children's tissue on UK tumour bank
Education and debate
BMJ 2005;331:401-403 (13 August)
Analysis of newspaper reporting shows how media scandals can affect scientific research, even when the research is not directly linked to the scandal

The consequences of controversies surrounding organs removed and retained from children after postmortem examination in the United Kingdom1 2 have been felt in diverse areas. The most obvious of these is pathology. Morale and recruitment of pathologists have been adversely affected,3 4 and rates of autopsy have fallen from already declining rates.4 Beyond pathology, levels of organ donation for therapeutic purposes such as transplantation have also fallen.5-7 Such effects may occur because, fuelled by mass media reporting, the public does not readily distinguish between organ retention and other uses of human tissues.8 Might there be links between media reporting and donation of tissues from children for ethically approved scientific research? (...)

Summary points
UK controversies about use of children's tissue have adversely affected the morale and recruitment of pathologists, rates of autopsy, and organ donation for therapeutic purposes

The organ retention story fitted a classic media scandal narrative and new events were portrayed as similar to the original story

Newspaper reporting blurred boundaries between donations from living children and those who had died and between different uses of tissues.

The intensity of media coverage was associated with a downturn in registrations of tissues in a national tumour bank

Medical staff may have been deterred from asking for donations by the negative publicity.

His death was ruled accidental

Hearing to determine legal standing at inmate's death inquest
winnipegsun.com 7.9.2006
A hearing is being held next Thursday to determine who will have legal standing at an inquest into the death of a Winnipeg Remand Centre inmate.

Christopher John Holoka, 29, died April 15, 2005, in his cell at the downtown facility. An autopsy found he died of a mixed drug overdose of methadone, paroxetine and ketamine. His death was ruled accidental.

People who want to be represented at the inquest can attend the Sept. 14 hearing, which begins at 9 a.m. in courtroom 408 at the Law Courts building.

The inquest will examine the circumstances of Holoka’s death and what can be done to prevent similar deaths in the future. Inquests are mandatory when a person dies in custody.

Dates have not been set. (...)

"More people are prepared to put deaths down as suicide rather than misadventure,"

Statistics show rise in suicides
belfasttoday.net 23.3.2007
SUICIDES rose by almost 40 per cent in Northern Ireland last year, new figures show.

Unemployment, association with other suicide victims and shortcomings in the mental health system are all thought to have contributed to the increase.

According to the provisional 2006 mortality statistics, published yesterday by the Northern Ireland Statistics and Research Agency (NISRA), the overall number of deaths recorded in the Province rose by just two per cent. (...)

Yesterday, he said the new figures showed just how bad the suicide "epidemic" is in Northern Ireland.

"Unless we get to grips with it, it will rise again," he said. "More people are prepared to put deaths down as suicide rather than misadventure, families have been working tirelessly to break down the barriers and stigma associated with this." (...)

"...attempts can be thwarted much easier"

A reason to live
chillicothegazette.com 14.1.2007
New coalition to focus on suicide prevention (...)

Mahaffey, who is continuing to look into the numbers of attempted suicides, said part of the increased number of completed suicides in Ross County is the availability of guns.

"I think it is higher because we have a culture that enjoys the freedom of the use of firearms, so they're around and they're available," Mahaffey said, adding that studies have shown that areas with fewer gun restrictions have higher numbers of completed suicides.

Suicide attempts done with guns are more often completed because of the damage guns do versus suicides where pills are taken because those attempts can be thwarted much easier, causing the number of completed suicides by poisoning to be lower.

However, the numbers of overdoses may be skewed locally because many of those incidents are sent to Columbus hospitals, Mahaffey said. (...)

Legemiddelindusert grand mal seizures

Local D.J.'s death accident, not homicide
kget.com 15.11.2006
- Local disc jockey Karen Garcia's 2005 death was an accident, not a murder, the coroner's office has decided. The ruling, announced this morning, comes after a near year-long homicide investigation. (...)

"Substantial amounts of Bupropion were detected," in the autopsy, said pathologist Dr. Steven Karch.

''The amount present was not consistent with an intentional overdose, but use of Bupropion, even at modest levels, is associated with the unpredictable occurrence of grand mal seizures, and these may be fatal." (...)

"...the doctor who treated the woman was horrified that he had burdened the family with the knowledge of her suicide..." (...) "..he would have flushed the pills down a sink and never mentioned having seen them."

Physician heard opportunity knocking in private forensic medicine field
commercialappeal.com 8.2.2007
One day Dr. Bruce Levy cut open a dead woman's stomach and found it was full of pills.

That discovery and the events that followed led Levy to pursue a career in forensic medicine. Today, the 46-year-old New Yorker is a businessman who remains active in finding out why people died.

"I think the opportunity to be able to study the human body is absolutely fascinating," he said.

Levy is Tennessee's medical examiner and president and CEO of Forensic Medical, the private firm that last year received a $2.5 million contract to administer the Shelby County Medical Examiner's office. (...)

But the turning point came when Levy discovered the pills in her stomach. His hospital happened to share space with the Massachusetts medical examiner, and experienced staffers led him through the investigation.

"It turned out that the woman had committed suicide," he said. "She had hoarded and overdosed on her heart medication."

Levy said the doctor who treated the woman was horrified that he had burdened the family with the knowledge of her suicide. The doctor told Levy that he would have flushed the pills down a sink and never mentioned having seen them.

"And I just found that outrageous," Levy said. "And I think it was probably then that I realized that this was something that was for me. That truth was very important."

The unfortunate souls who carry their mysteries to the autopsy tables on Madison Avenue have died by unexplained natural causes or by homicide, suicide, or accident. Their autopsies are meant to aid in investigations and explain their deaths to families. (...)

Levy argues that a private firm gives doctors more control over their work environment. (...)

Zoloft: MEDICAL EXAMINER QUESTIONING SHERIFF'S LAB RESULTS A SECOND TIME

MEDICAL EXAMINER QUESTIONING SHERIFF'S LAB RESULTS A SECOND TIME
infoweb.newsbank.com 15.7.1998 (The Palm Beach Post)
The sheriff's lab failed to find morphine and small amounts of benzodiazepines in an accidental overdose this year, documents show.

Carroll said the instrument used to test samples at the sheriff's lab is set by its manufacturer to detect a certain minimum level of benzodiazepines. Smaller amounts that appear in samples - such as the three cases Martin is questioning - aren't reported, he said.

"The bottom line is that there is a second class of drugs that were not reported or detected by the PBSO lab,'' Martin said.

She also said the sheriff's lab didn't report all the metabolized cocaine in a fourth case, which she has now labeled a cocaine death. Carroll said the lab doesn't report some forms of metabolized cocaine, because if the drug is not found in the blood, it didn't trigger the death.

And Martin said the sheriff's lab also didn't find Zoloft, an antidepressant, that caused an overdose. The Rochester lab's detection of the drug caused her to rule as suicide a 1996 case that had previously been labeled undetermined.

Carroll said he questions the other lab's detection of Zoloft. (...)

"She agreed to let us videotape the procedure"

Secrets Of The Dead Revealed
cbs2.com 8.5.2007
Every day hundreds of people die in Southern California and often they take the secrets of their deaths to the grave. But tonight, we have a rare and exclusive look at how the secrets of the dead are being revealed. We warn you that the images contained in our video report involve a real body and some footage may be considered graphic. (...)

Secrets Of The Dead Revealed (Warning - Graphic Content) (...)

Økende antall ulykkesdødsfall

Accidental fatalities are on the rise (Økende antall ulykkesdødsfall)
LATIMES.COM 11.6.2007
The nation's accidental death rate has been gradually creeping higher and is up 12% compared to the lowest rate on record, in 1992, according to a report released Thursday by the National Safety Council.

The independent, nonprofit group warned that if the trend continues, the nation could surpass the all-time high of 116,385 accidental deaths, set in 1969.

From 1969 until 1992, the rate of accidental deaths — a number adjusted for population growth — steadily declined. The council credited seat belts and air bags in vehicles, smoke detectors in homes and stiff drunken-driving laws with reducing deaths.

But ground is being lost because of increasing rates of falls among the elderly and accidental overdoses from legal and illegal drugs, said Alan McMillan, chief executive of the National Safety Council. Meanwhile, deaths from workplace accidents and car crashes have been fairly stable.

Older motorcycle operators also add to the death toll, McMillan said. Thirty-five percent of motorcycle deaths in 2005 were among bikers 45 and older. A decade ago, 15% of biker deaths were among the older group. (...)

Coroner: BHS Student Died From Respiratory Depression

Coroner: BHS Student Died From Respiratory Depression
wlox.com 5.9.2007
(...) The coroner says it was caused by respiratory depression, and it's not due to any injuries suffered from playing football. Family members believe the condition was caused by taking too much prescribed pain medication. (...)

RETTSMEDISINERS LEGEMIDDELFRYKT

CORONER’S DRUG FEARS (RETTSMEDISINERS LEGEMIDDELFRYKT)
NWEMAIL.CO.UK 14.3.2008
WORRIES: Coroner Ian Smith
SOUTH Cumbria coroner Ian Smith will contact drug authorities because he fears people are killing themselves after taking antidepressants.

Mr Smith is to write to the Committee on the Safety of Medicines – an independent advisory body on the quality and safety of medicines – following the inquest into the death of Nigel Woodburn.

Mr Woodburn drove into a tree just four days after being prescribed controversial antidepressants.

The retired bank manager, of Bardsea Green, was killed at the wheel of his car on June 16, minutes after confessing to his wife he’d had suicidal thoughts. He had been prescribed Citalopram after becoming depressed through ill health.

His heart-broken family said they were not aware of the suicide risks associated with antidepressants until the issue was highlighted at Mr Woodburn’s inquest this week.

Mr Smith told Tuesday’s inquest he knew of several other suspected suicides involving the same group of antidepressants, known as selective serotonin re-uptake inhibitors (SSRIs).

He said: “I have to say this is probably the fifth, if not sixth inquest I’ve heard within a period of three years when somebody either just going on to Citalopram or Seroxat, or coming off it, have killed themselves one way or another, totally out of the blue, totally without expectation, without a history of suicidal thoughts in the past.” (...)

- Utdanner ikke rettsmedisinere (- rettsmedisinerne vil ha spesialisering)

Utdanner ikke rettsmedisinere
nrk.no 6.4.2010
Norge er det eneste landet i Skandinavia som ikke har utdanning for rettsmedisinere. – Det er pinlig, sier professor.

Interessen for jobbene finnes, men altså ikke utdanningen. I Norge er det nå 10 leger som er rettsmedisinere.

– Det er ingen som tar ansvar for rettsmedisin i Norge. Det er bare to stillinger her på Vestlandet og ingen utdanningsstillinger, sier Inge Morild ved Gades institutt. (...)

Behovet vil øke
– Det finnes bare én utdanningsstilling i hele Norge, og den er i Oslo, sier leder i Norsk Rettsmedisinsk Forening.

De fortviler også over at Norge ligger langt bak. I fremtiden vil behovet for rettsmedisinere bare øke, ifølge Stray-Pedersen.

– Det har ikke vært noen godkjennelse for rettsmedisinere, det betyr at en i teorien kan kalle seg rettsmedisiner bare en er lege, sier han. (...)

Rettsmedisinerne vil ha spesialisering
dagensmedisin.no 6.4.2006
Norsk rettsmedisinsk forening har lenge ivret for en spesialistutdanning, men verken Legeforeningen eller myndighetene har tatt ballen. Foreningen har selv begynt å holde poenggivende kurs for sakkyndige i rettsvesenet.

- De fleste EU-landene har spesialistutdanning i rettsmedisin. Norge trenger også dette, sier professor Torleiv Ole Rognum, Rettsmedisinsk institutt ved Universitetet i Oslo. Han leder også Norsk rettsmedisinsk forening.
I påvente av at myndighetene etablerer en slik spesialistutdanning, har foreningen tatt i bruk en tretrinns kvalifisering av sakkyndige for rettsvesenet som er utarbeidet av Randi Rosenqvist. Det er imidlertid opp til domstolene om de vil benytte sakkyndige som har gjennomgått disse frivillige kursene. (...)

- Store mørketall når det gjelder selvmord blant eldre

Mener hjemmebesøk kan redusere selvmord
tv2nyhetene.no 15.11.2010
OPPFORDRER TIL BESØK: Overlege Ildri Kjølseth mener selvmord blant eldre kan unngås hvis helsetjenesten begynner med oppsøkende virksomhet.
Hvert år begår om lag 100 eldre selvmord i Norge. Overlege Ildri Kjølseth mener dette kan unngås.

Kjølseth har nettopp fullført en doktoravhandling om selvmord blant eldre. Hun mener alle eldre bør får besøk av helsetjenesten når de fyller 70 år.

Store mørketall
Som TV 2 viste søndag, kan være store mørketall når det gjelder selvmord blant eldre. En av grunnene til dette er at det er vanskelig å finne egentlig dødsårsak hos eldre mennesker.

– Det har vært større oppmerksomhet rundt denne problematikken i andre land. I Norge har vi ikke vist noen ting om dette, og det har nesten ikke vært tatt opp i det hele tatt. (...)

Diverse artikler

Another doctor should investigate all hospital deaths
BMJ 2012;344:e3349 (11 May)
I’m going to get stick for saying this, but here goes. Surgeons are better at dealing with death than physicians, no matter how counterintuitive this generalisation might seem given the stereotypes involved.

When a patient dies in hospital we physicians deal with the family sympathetically, express our sorrow, and move on. There’s always another patient to see, another long letter to dictate.

Our surgical colleagues, however, take a different approach. They too express sympathy and sadness, but they also tend to take the death more personally. “Why did this happen?” they want to know. “What’s to stop this happening again?” And then comes the inevitable “Who is responsible?” while the registrar dutifully stares at his or her shoes in contrition.

And after the harangue, the hunt for a cause begins. Notes are examined. People involved with the care are interviewed. Ultimately, a judgment is made. Then all the findings are made public, with other consultants adding their thoughts. (...)

GPs required to report all ‘unexpected’ deaths to CQC
pulsetoday.co.uk 16.4.2012
GPs are to be required to report all ‘unexpected' deaths of patients who have received recent treatment to the Care Quality Commission, in a move designed to prevent a future Shipman going undetected.

CQC officials will respond to reports by interviewing GPs and inspecting practices, particularly where more than one death is reported over a short space of time.

The new requirement – published last week in a list of new requirements on the Department of Health's website – prompted immediate criticism from the GPC, which said it would be ‘burdensome' on GPs and duplicate information already reported to the Coroner. (...)

Frykter drap ikke blir oppdaget når færre obduseres
nrk.no 12.3.2012
Hvert år blir det utført færre undersøkelser i norske obduksjonssaler. Det kan føre til at drap ikke blir oppdaget.

Rettsmedisinere advarte om dette for ti år siden, men likevel blir færre obdusert nå enn før.

– Man kan aldri se på en person utvendig hva dødsårsaken er, bortsett når vedkommende har en kniv i ryggen.

Det sier Inge Morild, som er professor i rettsmedisin ved Gades Institutt i Bergen. De siste årene har han fått stadig færre inn til undersøkelse. (...)

Politiet – Vi følger bare instruksen
– Politiet følger regelverket, vi reduserer ikke antall obduksjoner for å spare penger, sier Svein Erik Krogvold.

Men politiet i Hordaland avviser at de tenker på pris og kostnader når de bestiller obduksjoner. De mener de bare følger reglene bedre.

– Uansett om man obduserer 150 eller 250 personer, så kan det være en mulighet for at det er noe man ikke oppdager. Det sier politiinspektør Hordaland politidistrikt, Svein Erik Krogvold. (...)

Fewer Autopsies Mean More Hospital Errors
digitaljournal.com 6.3.2012
When a patient dies in a hospital, there is a 5 percent chance that an autopsy will be conducted; in the 1950s, that number was 50 percent. Learn how this change has negatively impacted health care.

- Autopsies have served a vital role in modern medicine for centuries. Autopsies educate the medical community about sickness and death, the nature and progression of disease, and the diagnosis and treatment of illness.

The intellectual founder of the autopsy was Giovanni Morgagni. Morgagni documented the importance of autopsy in his work "The Seats and Causes of Disease Investigated by Anatomy."

The Ascent and Decline of Medical Autopsies

Morgagni argued in this work, published in 1761, that illness is not a supernatural or intangible property. Rather, he claimed, illness is observable and physical, requiring empirical investigation aimed at determining precise physical processes. (...)

Too many’ suicides linked to depression tablets (For mange selvmord linket til depresjonstabletter)
irishexaminer.com 5.3.2012
A former assistant state pathologist has expressed serious concern about the growing link between anti-depressants and suicide.

Dr Declan Gilsenan said in his 30-year experience carrying out postmortems, he had seen "too many suicides" after people had started taking the drugs and questioned whether GPs were over-prescribing them.

He said the evidence is "more than anecdotal" and he is willing to meet the minister with responsibility for mental health on the issue, as part of a delegation organised by campaigner Leonie Fennell.

Ms Fennell is the mother of Shane Clancy, who took his own life after killing his friend Sebastian Creane.

He had just started a course of anti-depressants and it is believed he took more than the prescribed amount.

At Mr Clancy’s inquest, Dr Gilsenan testified that there were "toxic" levels of citalopram (brand name Celexa or Cipramil) in Mr Clancy’s blood.

Ms Fennell has been campaigning since Mr Clancy’s death to raise awareness about the potential dangers of anti-depressants and is seeking a meeting with Kathleen Lynch, minister of state with responsibility for mental health. (...)

Obduksjonens betydning for registrering av dødsårsak
Tidsskr Nor Legeforen 2012; -1868:147-51
(...) Bakgrunn. Ved mer enn 90 % av dødsfallene i Norge er dødsmeldingen eneste informasjonskilde for registrering av underliggende dødsårsak. Ved bare en liten andel av tilfellene foreligger det tilleggsinformasjon, som regel fra sykehusobduksjon eller rettslig obduksjon. Vi ønsket å undersøke hvor hyppig funn ved sykehusobduksjon påvirker fastsettelsen av underliggende dødsårsak.

Materiale og metode. Med utgangspunkt i Dødsårsaksregisteret bestemte vi ut fra dødsmeldingen underliggende dødsårsak for dødsfall der det ble utført sykehusobduksjon i 2005. Deretter undersøkte vi om underliggende dødsårsak ble endret når vi tok hensyn til obduksjonsfunnene.

Resultater. I 2005 var det 41 152 dødsfall i Norge. Dødsårsaksregisteret mottok resultat av sykehusobduksjon for 1 773 døde, med alder fra to år og oppover. Obduksjonsfunn førte til endring av underliggende dødsårsak for 1 077 (61 %) dødsfall. For 567 dødsfall (32 %) var endringen stor og medførte skifte av ICD-10-kapittel for dødsårsaken. Andelen endrede dødsårsaker var større i de yngste og de eldste aldersgruppene og for kvinner.

Fortolkning. Sykehusobduksjon er et viktig korrektiv når det gjelder fastsetting av underliggende dødsårsak. (...)

Researchers probe century-old brains for clues to mental illness
news.medill.northwestern.edu 18.1.2012
Century-old brains preserved in jars at the Indiana Medical History Museum may provide more than an interesting exhibit.

New research suggests they might hold a key to better treatment for mental disorders such as bipolar disease and schizophrenia.

The museum, formerly the Central Indiana Hospital for the Insane, archives about 400 brain samples collected from patient autopsies performed between 1896-1942. Indiana University School of Medicine pathologist George Sandusky moved the brains - a few at a time - from museum to lab starting in 2010.

He has been working with graduate students to extract DNA from the brains for comparison with modern samples, he said. (...)

Organisering og nytteverdi av obduksjon
Tidsskr Nor Legeforen 2012; -1868:152-4 (24.1.2012)
(...) Bakgrunn. De siste tiårene har det skjedd en betydelig reduksjon av obduksjonsfrekvensen. Vi ville undersøke om leger synes at dette er en riktig utvikling, eller om de vil at obduksjon skal prioriteres høyere og i så fall hvordan.

Fortolkning. Sykehusleger oppfatter fortsatt obduksjon som et godt middel til kvalitetssikring av klinisk arbeid. Kortere svartid for obduksjon, og bedre kommunikasjon mellom klinikere og patologer, er forhold som bør prioriteres. (...)

Our Nation's Hidden Elderly Deaths Scandal
technorati.com 26.12.2011
Last week we reported about the shockingly deficient numbers of hospitals that do not conduct autopsies, and, as a result, miss important diagnostic and/or treatment lessons from the results.

In a related and equally disturbing reality, when elderly people die under suspicious circumstances, the reasons often remain unknown, because autopsies are seldom performed on people older than 65. The investigative report by ProPublica and PBS Frontline says that no one knows how many of these suspicious deaths have been ascribed to “natural” fatalities, and how many, in fact, were the result of elder abuse or mistreatment. The report quotes a U.S. Department of Justice researcher describing the situation as “a hidden national scandal.”

The system of investigating the cause of suspicious deaths is compromised by insufficient funds, a shortage of trained medical personnel and lack of national standards that, the writers conclude, sometimes have “helped to send innocent people to prison and allowed killers to walk free. When it comes to the elderly, the system errs by omission.”

Specifically, here’s how the system discourages appropriate scrutiny of senior citizen deaths: (...)

Studying dogs from war zone helps with troops’ illnesses
suntimes.com 1.1.2012
More than 400 U.S. war dogs that served tours in Iraq and Afghanistan are now playing a role in understanding illnesses that have befallen some American troops deployed to the Middle East.

A database of the medical records of 450 military working dogs — some of whom spent years at war — will be studied to identify trends in diseases they suffered and any similarities with the sicknesses of troops, especially those that might be connected to exposure to environmental health hazards.

The Veterans Affairs Department’s Gulf War Veterans’ Illnesses Task Force also will analyze tissue samples from the autopsies of the dozens of dogs that died during their war service. (...)

Tests on fetus can help explain stillbirth, study says
abcactionnews.com 27.12.2011
Stillbirths are about as common as infant deaths, but they remain a largely unacknowledged loss.

Shining light on the difficult subject -- by doing extensive testing -- can help parents find closure and possibly avoid another loss, according to Dr. Robert Silver, who is part of a national network created to reduce stillbirths.

His research shows that performing an autopsy, evaluating the placenta and genetically testing the fetus can provide a probable or possible cause of death in 76 percent of the stillbirths studied, according to an article he wrote for the Journal of the American Medical Association, released Dec. 13. (...)

(Anm: Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation. JAMA. 2011;306(22):2469-2479 (December 21).)

Calls for more post-mortems after natural deaths
bbc.co.uk 13.12.2011
13 December 2011 Last updated at 13:19 GMT
After a post-mortem examination doctors try to leave as little scarring on the body as possible

With 30% of death certificates in the UK found to be inaccurate, there are calls for more consented post-mortem examinations to be carried out to check the cause of natural deaths. (...)

Professor Lucas remembers performing about a dozen post-mortem examinations a week to clarify why people died, teach medical staff and students, and improve clinical practice. But now he performs just one a week.

He believes this is a huge loss to medical science in terms of information and educational material.

"National statistics show that roughly 30% of death certificates are wrong - in a major or less than major way," he says.

"We are throwing away potentially valuable information by not doing more of the consented post-mortems," to find out what really caused their death.

He believes they would be a great source of information for cancer research and treatment in particular. (...)

Psykisk syge dør 20 år for tidligt
b.dk 2.12.2011
Psykisk syge dør i vid udstrækning af fysiske sygdomme som kræft og diabetes. Nu skal de screenes.

Psykisk syges fysiske sygdom

• Den gennemsnitlige levetid for mennesker med psykisk sygdom er cirka 20 år kortere end for resten af befolkningen.
• Cirka 40 procent af overdødeligheden skyldes eksterne årsager (primært selvmord), mens cirka 60 procent kan tilskrives somatiske sygdomme/medicinske tilstande.
• Patienter med depression har dobbelt så stor risiko for at få en hjertesygdom.
• Patienter med depression har 65 procent øget risiko for at udvikle diabetes.
• Patienter med skizofreni har tre gange større risiko for diabetes.
• Patienter med skizofreni har dobbelt så stor dødelighed på grund af hjertekarsygdomme.
• 75 procent har en eller flere fysiske sygdomme.
• Kun halvt så mange psykisk syge med hjertesygdomme opereres sammenlignet med patienter uden psykisk sygdom. (...)

Psykisk syge lever i gennemsnit 20 år kortere end danskere uden en psykiatrisk diagnose. De dør i vid udstrækning af fysiske sygdomme som for eksempel diabetes, kræft og hjertelidelser, fordi de har svært ved at passe på sig selv, og fordi sundhedsvæsenet ikke formår at sikre dem en ordentlig behandling.

Det fremgår af et nyt udspil fra Danske Regioner, der nu går i offensiven for at forbedre både forebyggelsen og behandlingen af fysiske sygdomme blandt psykisk syge. Det skal blandt andet ske ved at screene psykisk syge for forskellige fysiske sygdomme samt risikoadfærd, når det gælder rygning, usunde madvaner, mangel på motion og et højt alkoholforbrug, som er mere udbredt blandt psykisk syge end i befolkningen som helhed.

»Fysisk sygdom blandt psykisk syge er klart et overset problem. Det er rystende og helt uacceptabelt, at psykisk syge lever 20 år kortere i et samfund som vores, hvor vi bryster os af at have en høj social profil og går meget op i lighed. Det skal der rettes op på. Overdødeligheden blandt psykisk syge skal reduceres væsentligt,« siger formand for Danske Regioner Bent Hansen (S).

Ud over screening vil regionerne også gå efter at sikre mennesker med en langvarig psykisk sygdom regelmæssige helbredstjek. Der skal mere fokus på bivirkninger ved antipsykotisk medicin i form af blandt andet risiko for vægtøgning, og samarbejdet mellem psykiatrien og det øvrige sundhedsvæsen skal styrkes både med aftaler om gensidige tilsyn og undervisning.

Fysiske sygdomme overses
Udspillet kommer, efter at en fælles nordisk undersøgelse tidligere på året påviste en markant overdødelighed blandt psykisk syge, som i væsentligt omfang kan tilskrives såkaldte somatiske (fysiske, red.) sygdomme og medicinske tilstande, ikke mindst livsstilssygdomme som diabetes, hjertekarsygdomme og kræft. (...)

Både fagfolk og patientorganisationer hilser udspillet velkomment.

»Der er ingen tvivl om, at psykisk syge underbehandles, og det er den rigtige vej at gå at tænke psykiatrien og somatikken sammen. Vi skal kunne rumme hele patienten,« siger formand for Lægeforeningen Mads Koch Hansen. (...)

Ifølge Bent Hansen »behøver det ikke at koste en bondegård« at gennemføre udspillet, og i Folketinget er Socialdemokraternes sundhedsordfører, Sophie Hæstorp Andersen, klar til at sætte problemet på dagsordenen: »Det er en meget markant overdødelighed. Hvis man er psykisk syg, skal det jo ikke nødvendigvis være sådan, at man så også skal dø af en livsstilssygdom.« (...)

Nu skal de mistænkelige selvmord undersøges
bt.dk 24.11.2011
B.T.s artikelserie om mistænkelige selvmord får nu konsekvenser. Læs meget mere på bt.dk/mordellerselvmord.

En ny arbejdsgruppe skal kulegrave politiets håndtering af mistænkelige dødsfald og mulige selvmordsager. Det sker efter en række artikler i B.T.

Det fremgår af en skriftlig redegørelse, som justitsminister Morten Bødskov (S) sent onsdag sendte til den tidligere formand for Folketings Retsudvalg, Peter Skaarup (DF).

Arbejdsgruppen bliver nedsat som følge af en igangværende artikelserie i B.T., som de seneste måneder har afsløret en lang række alvorlige svigt i politiets håndtering af flere konkrete dødsfald. Dødsfald, som på et særdeles spinkelt grundlag er blevet henlagt som selvmord, selvom flere spor tyder på, at der reelt kan være om drab.

Flere erfarne efterforskere og retsmedicinere siger, at politiets indsats på området er præget af dovenskab og manglende evner.

Det er en denne kritik, den nye arbejdsgruppe skal forholde sig til. Arbejdsgruppen kommer til at bestå af repræsentanter fra anklagemyndigheden, Rigspolitiet, de retsmedicinske institutter, embedslægeinstitutionen og de enkelte politikredses øverste juridiske og politiuddannede ledelse.

Ifølge skrivelsen fra justitsministeren bliver gruppens opgave at beskrive og analysere politiets praksis på området med henblik på at højne kvaliteten.

Samtidig skal den danske indsats sammenlignes med den, der findes i de øvrige nordiske lande. Her obduceres selvmordsofre blandt andet langt hyppigere end det sker i Danmark. Det har ikke været muligt at få en kommentar fra justitsminister Morten Bødskov.

Torsdag er han imidlertid kaldt i samråd i Folketingets Retsudvalg for at svare på en række kritiske spørgsmål afledt af den igangværende artikelserie i B.T. (...)

Magnetkamera räcker inte för att fastställa dödsorsak
dagensmedicin.se 23.11.2011
Rutinmässig bilddiagnostik kan ännu inte ersätta traditionella obduktioner.

Den slutsatsen drar brittiska forskare efter att ha undersökt hur tillförlitlig datortomografi respektive magnetkamerateknik är för att fastställa dödsorsaken hos avlidna som skickats för obduktion.

I studien i tidskriften Lancet kommer de fram till att man med hjälp av sådan teknik kan fånga dödsorsaken i två av tre fall.

Men tekniken behöver utvecklas - i dag missar den ofta vanliga orsaker till plötslig död, enligt forskarna.

De tittade närmare på 182 vuxna avlidna som tagits till obduktion. Samtliga undersöktes med både datortomografi och magnetkamera innan de obducerades.

Resultaten visar att datortomografi var mer tillförlitligt än magnetkameraundersökning för att identifiera dödsorsaken.

Dödsfall på grund av kranskärlssjukdom, lungembolism och lunginflammation hörde till dem där bilddiagnostiken oftast inte räckte till.

Forskarna drar slutsatsen att datortomografi och magnetkamera ännu inte kan ersätta traditionella obduktioner.

Bakom studien står bland andra forskare vid John Radcliff Hospital i Oxford, Storbritannien. (...)

Will CT Scans and MRIs Kill the Autopsy? (Vil CT-skanninger og MRI erstatte obduksjoner)
blogs.scientificamerican.com 21.11.2011
Instead of cutting into a dead body to determine the cause of death, some coroners are already calling in a radiologist. But can CT (computed tomography) and MRI (magnetic-resonance imaging) tests accurately assess the recently deceased?

Formal autopsies have been on the decline for decades, due in part to tightening budgets. In the U.S. less than a quarter of deaths are followed with an autopsy, and previous research has shown that about a third of deaths have an incorrect causes listed on the death certificate. To lower cost and to help families whose religions prohibit post-mortem dissection, non-invasive imaging technology has been gaining favor. Some evidence had suggested, however, that CTs and MRIs are not quite as reliable as a traditional autopsy.

A new U.K. study of 182 adult deaths shows that more than half the time, a radiologist could pinpoint the cause of death with just a scan. But in 42 percent of CT scans and 32 percent of MRIs (and 30 percent of cases that used both), the radiologists’ assessments differed from those from a full autopsy. The research was led by Ian Roberts, of the cellular pathology department at John Radcliffe Hospital in Oxford, and the results were published online Monday in The Lancet.

“Post-mortem imaging cannot yet be regarded as a universal substitute for autopsy,” James Underwood, of the University of Sheffield, wrote in an essay in the same issue of the journal.

Imaging analyses were particularly poor at picking up certain common causes of death, including artery blockage (pulmonary embolism) and pneumonia. But they surpassed autopsy in a few areas, such as collapsed lungs and some bone fractures. Another benefit would be their longevity, remaining available for re-analysis long after tissue samples would have been discarded. (...)

(Anm: Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet, Early Online Publication, 22 November).)

Prescription Painkiller Overdoses in the U.S. (Overdoser av smertestillende i USA)
cdc.gov 1.11.2011
Overdose deaths from prescription painkillers have skyrocketed in the past decade. Every year, nearly 15,000 people die from overdoses involving these drugs—more than those who die from heroin and cocaine combined.

Overdoses involving prescription painkillers—a class of drugs that includes hydrocodone, methadone, oxycodone, and oxymorphone—are a public health epidemic. These drugs are widely misused and abused. One in 20 people in the United States, ages 12 and older, used prescription painkillers nonmedically (without a prescription or just for the "high" they cause) in 2010. A recent CDC analysis discusses this growing epidemic and suggested measures for prevention. (...)

Information on the proper storage and disposal of medications can be found at www.cdc.gov/HomeandRecreationalSafety/ Poisoning/preventiontips.htm. (...)

Doctors call for new inquest into death of UN weapons inspector David Kelly
BMJ 2011; 343:d5802 (12 September)
Doctors who question how the UK government scientist and United Nations weapons inspector David Kelly met his death have filed papers at the High Court in London seeking a judicial review of the decision by the attorney general for England and Wales, Dominic Grieve, not to allow a new inquest.

Dr Kelly, who was a weapons inspector in Iraq, was found dead in woods near his Oxfordshire home on 18 July 2003, three days after he was grilled by MPs at a televised hearing of the House of Commons foreign affairs select committee. His name had been leaked to the press as the source of a BBC story claiming that the then Labour government had “sexed up” a report to say that Iraq had weapons of mass destruction, to justify invasion.

The same day the body was found the then lord chancellor, Charles Falconer, announced an ad hoc inquiry into the circumstances surrounding the death, chaired by the law lord Brian Hutton. An inquest was opened by the Oxfordshire coroner, but Lord Falconer used his powers under the Coroners Act, where a public inquiry is held into a death, to require the coroner to adjourn the inquest.

The sole applicant for judicial review is David Halpin, a retired consultant orthopaedic and trauma surgeon, but his application is backed by four other doctors and funded so far by £35 000 (€40 000; $56 000), much of it raised from public donations through the website www.inquest4drdk.co.uk.

The doctors claim that the inquiry, which did not take evidence under oath, left “a significant gap in the forensic analysis.” They dispute the finding of the forensic pathologist Nicholas Hunt that Dr Kelly’s death was caused mainly by bleeding from a cut he made to his wrist (BMJ 2010;341:c6013, doi:10.1136/bmj.c6013). (...)

Färre obduktioner oroar revisorer
dagensit.no 15.8.2011
Antalet obduktioner i Gävleborgs län har minskat dramatiskt de senaste åren. Det visar en granskning som landstingets revisorer har gjort.

Revisorerna menar att minskningen är så anmärkningsvärd att frågan bör tas upp till diskussion i landstinget för att reda ut vilken nivå antalet obduktioner bör ligga på, rapporterar Sveriges Radio Gävleborg. Socialstyrelsen menar också att obduktioner är väsentliga för att hålla koll på kvaliteten inom sjukvården. (...)

Brist på resurser innebär också att många planerade obduktioner måste ställas in, då allt för lång tid gått efter dödsfallet.

Undersökningen visar även på en ojämn könsfördelning där obduktioner av män är klart vanligare. Bara en fjärdedel av förra årets obduktioner genomfördes på kvinnor. Detta bör också granskas närmare, menar revisorerna. (...)

– Det verste jeg har opplevd
uib.no 9.8.2011
For rettsmedisiner Inge Morild var identifiseringsarbeidet av de mange unge etter Utøya-drapene det verste han har vært med på. – At det så og si bare var ungdommer gjorde Utøya til noe helt spesielt, sier Morild. (...)

Påkjenning
Inge Morild var hjemme i Bergen da terroristen slo til i regjeringskvartalet og på Utøya. Han ble raskt klar over at patologene i Oslo ikke kunne klare arbeide alene og ga derfor beskjed om at han var ledig. Deretter reiste han til Rikshospitalet for å delta i identifiserings- og obduksjonsarbeidet. I tillegg til Inge Morild, deltok rettsodontolog Anne Christine Johannesen og forskningstekniker Torbjørg Hamrebø fra UiB.

På Rikshospitalet ble patologene inndelt i fem team. Til tross for sterke inntrykk og et sterkt sinne rettet mot gjerningsmannen, klarte identifiserings- og obduksjonsteamet på Rikshospitalet å opprettholde en god tone og arbeidet effektivt, forteller Morild. Arbeidet startet mandag og ble ferdig to dager senere.

Flere av patologene inngår i Kripos' faste ID-team. Denne består av rundt 40 faste medlemmer. Dette er rettsmedisinere og rettsodontologer fra universitetene i Bergen, Oslo, Trondheim og Tromsø. Ved større ulykker med flere omkomne enn de lokale kreftene klarer å håndtere, kalles gruppen inn for å hjelpe til.

Gruppen er godt trent til å takle de mentale påkjenningene som obduksjons- og identifiseringsarbeidet medfører. Etter spesielle hendelser er det likevel en utfordring. (...)

Autopsy decline skews suicide rates (Redusert antall obduksjoner gir skjeve selvmordsrater)
imt.ie 3.8.2011
Caution should be used when comparing international suicide rates as many countries registering a decline in suicide show a corresponding drop in autopsies, international research shows.

The authors of the study concluded that autopsy rates were a “major predictor” for suicide rates, and “may [therefore] affect the validity of suicide statistics”.
The current analysis involved data from 35 European and Asian countries during a roughly 30-year period to 2007 and used autopsy rates as an external measure of validation of cause-of-death-statistics.

Writing in the Archives of General Psychiatry, the authors noted a consistently strong positive correlation between autopsy rates and suicide rates for all three decades of the study. For example, cross-sectional estimates showed that a 1 per cent difference between national autopsy rates was associated with a suicide rate difference of 0.49 per 100,000 population. (...)

Furthermore, declining suicide rates in Europe suggested these decreases harboured a “sizeable artifactual component” that warranted in-depth investigation. (...)

(Anm: Declining Autopsy Rates and Suicide Misclassification (Reduserte obduksjonsrater og feilklassifisering av selvmord) Arch Gen Psychiatry. 2011;68(10):1050-1057 (October) (pdf).)

Sygehuse dropper obduktioner
politiken.dk 9.8.2011
Vigtig viden om behandling og sygdomme går tabt, advarer flere eksperter.

Antallet af obduktioner styrtdykker, og Danmark går glip af så meget vigtig viden, at det nu får fagfolk til at slå alarm.

Hvor man i 1985 obducerede 28,4 procent af andelen af naturlige dødsfald i Danmark, blev blot 3,7 procent obduceret sidste år, viser beregninger foretaget af Afdeling for Klinisk Patologi ved Svendborg Sygehus. Det drastiske fald bekymrer ledende overlæge på afdelingen Michael Hardt Madsen.

»Obduktioner giver lægevidenskaben meget vigtig viden og handler om at sikre sig, at lægerne ikke har overset noget i deres arbejde«, siger han til Politiken.

Gav tidligere afgørende viden
Tidligere har obduktioner givet afgørende viden om hiv og aids og identificeret nye hjertesygdomme. Men nye tiltag som CT-skanningerne og røntgenbilleder har presset antallet af obduktioner ned.

Formand for Danske Regioner Bent Hansen (S) forklarer udviklingen med hospitalernes prioriteringer: »Der er pres på ressourcerne«, siger han til Politiken. (...)

Police plan to increase autopsies (Politiet planlegger å øke antall obduksjoner)
japantimes.co.jp 27.7.2011
The government set up a high-level working group Tuesday to study how to better identify causes of death when foul play is suspected and increase autopsies in such cases, according to officials.

The government made the decision in a ministerial meeting on crime that was attended by Prime Minister Naoto Kan and all 17 Cabinet ministers.

The National Police Agency said police forces nationwide in 2010 handled more than 170,000 people who apparently died of unnatural causes but only performed autopsies on 11 percent of them.

The government plans to raise the rate to 20 percent over the next five years, the officials said.

Kan instructed the ministers to work out measures to avoid failing to identify deaths resulting from foul play.

The working team will discuss how to increase the number of anatomy experts from the current 170, expand testing for pharmaceutical and poisonous materials, and build up databases of dental records and DNA, the officials said.

The NPA said at least 43 murder cases since 1998 involved causes of death that were initially judged as suicide or disease-related. (...)

FDA Warns About Nervous System Reactions from Zyvox, Methylene Blue (FDA advarer om reaksjoner i nervesystemet fra Zyvoxid (Zyvox), Methylene Blue)
aboutlawsuits.com 27.7.2011
Federal drug regulators are warning that there is a risk of serious central nervous system reactions when the drugs Zyvox and methylene blue are used with some antidepressants, including Paxil, Zoloft, Prozac and Cymbalta, among many others.

The FDA issued a drug safety communications for methylene blue and Zyvox on Tuesday, indicating that the agency analyzed adverse event reports that included reports of central nervous system (CNS) toxicity and some deaths. The reactions were due to drug interactions between the two drugs and psychiatric medications that affect the serotonin system of the brain, according to the FDA warning.

Methylene blue and Zyvox are both reversible monoamine oxidase inhibitors (MAOI). Methylene blue is used to treat cyanide poisoning, methemoglobinemia, vasoplegic syndrome and ifosfamide-induced encephalopathy. It is also used as a dye in therapeutic and diagnostic applications. Zyvox (linezolid) is used to treat infections, including pneumonia, skin infections and methicillin-resistant Staphylococcus aureus (MRSA).

The FDA warning includes a full list of serotonergic psychiatric medications that could react with the drugs. The list includes selective serotonin reuptake inhibitors (SSRIs), which are the most common psychiatric drugs on the market, as well as tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) and other MAOIs and psychiatric drugs. The list includes some of the most prescribed drugs in the world, such as Paxil, Prozac, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, Wellbutrin and Zyban.

Why the interaction between the drugs causes CNS toxicity is unknown, but the FDA states that some experts believe that the Zyvox and methylene blue cause high levels of serotonin to build up in the brain when used with the serotonergic drugs, resulting in toxicity. This is known as serotonin syndrome and can cause confusion, hyperactivity, memory loss, muscle twitching, excessive sweating, shivering and shaking, diarrhea, fever and trouble with coordination.

The agency is recommending that patients prescribed methylene blue and Zyvox should be taken off of any of the listed antidepressants two weeks prior. However, in some cases the drugs are given as an emergency treatment. In those instances, doctors should attempt to find an alternative method of treatment, the FDA recommended.

The antidepressants can be resumed 24 hours after the last dose of methylene blue and Zyvox, the FDA stated.

(Anm: linezolid (antibiotika; Zyvox i USA); Zyvoxid (in Europe), and Zyvoxam (in Canada and Mexico). Generics are also available in India, such as Linospan (Cipla). (en.wikipedia.org).)

(Anm: Serotonin syndrom (SS), kramper, parkinsonisme osv. (forhøyet kroppstemperatur) (mintankesmie.no).)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

Brain Autopsies of Four Former Football Players Reveal Not All Get Chronic Traumatic Encephalopathy
sciencedaily.com 26.7.2011
— Preliminary results from the first four brains donated to the Canadian Sports Concussion Project at the Krembil Neuroscience Centre, TorontoWesternHospital, reveal that two of the four former Canadian Football League (CFL) players suffered from a brain disease known as Chronic Traumatic Encephalopathy (CTE), while two did not show signs of CTE.

Bobby Kuntz, a former Toronto Argonaut and Hamilton Tiger-Cat and Jay Roberts, an Ottawa Roughrider both had a history of repeated concussions during their careers and showed the characteristic signs of CTE, an abnormal build-up of a protein called Tau in the brain, and other degenerative changes.

CTE can result in memory impairment, emotional instability, erratic behavior, depression, and problems with impulse control. CTE may eventually progress to full-blown dementia. Dr. Hazrati is very clear, however, to emphasize that the precise relationship between concussions and neurodegeneration remains to be demonstrated by future research. (...)

Obduksjoner. Mest populært på fjernsyn
MICHELLE ANDREWS - The Washington Post
aftenposten.no 24.5.2011
Amerikanske krimserier har popularisert obduksjoner, men i virkeligheten blir slike medisinske likåpninger sjeldnere for hvert år som går.

Rettsmedisinske TV-programmer dominerer nå detektiv-sjangeren i USA og rundt i verden. En hel serie med filmer handler i større eller mindre grad om obduksjoner,
for eksempel «CSINew York», «CSI-Miami», «Criminal Minds», «Without a Trace » og «Cold Case».Mendette er mer og mer fiksjon.

Amerikanske sykehus, for eksempel, gjennomfører i dag obduksjoner på bare fem prosent av pasientene som dør – en nedgang fra 50 prosent i 1960-årene. Dette er uheldig, sier ekspertene, fordi detaljer om dødsårsaken kan være av stor betydning for både familiene til de døde og for sykehusene – selv om undersøkelsene ikke avslører noen udiagnostisert sykdom eller annen ny informasjon om dødsårsaken. (...)

Decline In Autopsies May Obscure Understanding Of Disease (Nedgang i antall obduksjoner kan skjule forståelsen av sykdom)
gantdaily.com 17.5.2011
United States (KaiserHealth) – Television crime shows have helped popularize autopsies, but in reality these postmortem exams are becoming rarer every year.

Today, hospitals perform autopsies on only about 5 percent of patients who die, down from roughly 50 percent in the ’60s. That’s unfortunate, say experts, because details about the cause of death can be illuminating for both families and hospitals, even if they don’t turn up an undiagnosed ailment or other new information about the cause of death.

Kristine Johnson’s father, Nathan Johnson, developed early-onset Alzheimer’s disease and died last August, five years after having received that diagnosis at age 52. He worked as a lineman for a power company near the family home in Waterford, Conn., and had on occasion been injured by powerful jolts of electricity, says Kristine, who is 36. She hoped that an autopsy would provide some answers, possibly related to injuries he sustained on the job, about why he developed Alzheimer’s at such an early age. (Most people who develop Alzheimer’s do so after age 65; only about 5 percent of cases are early-onset.) (...)

Ny teori om Darwins død
b.dk 13.5.2011
Charles Darwin led af et utal af sygdomme, som til sidst slog ham ihjel. Men først nu stilles en præcis diagnose.

Det er blevet en mode at grave gamle lig af berømte mennesker op for at fastslå, hvorfor de døde. Tænk blot på vor egen Tycho Brahe, hvis lig blev underkastet undersøgelser.

En række andre verdenskendte historiske figurer, som døde mystisk eller uforklarligt, har fået endevendt deres data for at fastslå, hvorfor de pludselig gik bort som f.eks. Christopher Columbus, Florence Nightingale, Alexander den Store og andre.

Nu er turen nået til Charles Darwin, som var den naturvidenskabsmand, der skabte teorien om, at arternes udviklingshistorie var styret af den stærkestes overlevelsesevne. Nu var Charles Darwin ikke af den stærke fysiske type. Charles, der var født i 1809, led af et utal af sygdomme allerede da han var en ganske ung mand. Han kastede ofte op og havde kroniske mavesmerter. Senere i livet udviklede han et væld af sygdomme, der gav ham konstante smerter.

Da han var 73, blev han svagere og hans hukommelse svigtede ham. Han kom til at lide af svimmelhed og i løbet af 3 måneder blev han så svag, at han døde af et hjerteanfald under en kravletur over nogle klipper. Ifølge sine børn hviskede han til hustru Emma, som sine sidste ord: "Jeg er ikke det mindste bange for døden. Husk hvilken god kone, du har været for mig. Fortæl alle mine børn, at de har været gode ved mig." (...)

I år var det altså Darwin, der stod for tur og prof. Sidney Cohen, der er leder af Jefferson Medical College i USA, kastede sig over Darwins sygdomshistorie på konferencen, dog uden at præsentere noget opgravet lig.. Cohen mener, at Darwin led af en parasit, der giver sig udslag i netop de symptomer, som Darwin led af. Sygdommen kaldes Chagas sygdom og Darwin fik sandsynligvis parasitten, da han rejste med skibet HMS Beagle for at observere dyr bl.a. på fjerne øgrupper. Hvis man ikke behandler Chagas så kan man udvikle hjerteproblemer, som netop var det, Darwin døde af.

Darwin led desuden af kraftige opkast og maveproblemer. Cohen mente, at Darwin foruden Chagas-parasitten muligvis har haft et angreb af Helicobacter pylori, som er en bakterie, der angriber maven og kan give mavekræft.

Cohen siger, at Darwin led af et antal sygdomme og at han ikke var et stærkt kort at stikke ud til en livsforsikring. Ingen af Darwins samtidige kendte disse sygdomme, siger Cohen, så de havde ikke en ærlig chance for at vide, hvad han egentlig led af.

Charles Darwin døde 19. april 1882. (...)

(Anm: Chagas' sykdom, infeksjonssykdom som opptrer i Sør- og Mellom-Amerika fra Mexico til Argentina. Fremkalles av en trypanosom-art, Trypanosoma cruzi, som overføres til menneske eller andre pattedyr av blodsugende teger, chagasteger. Sykdommen ytrer seg ved hevelser i hud og underhud, senere i lymfeknuter, milt- og leverforstørrelse, feber, blodmangel og angrep på hjertet. Forløpet kan være akutt, ondartet eller kronisk, årelangt. Sykdommen ble oppdaget av den brasilianske legen C. Chagas (1879–1934) i 1909. Ingen virksom behandling er kjent. Kilde: Store norske leksikon.)

(Anm: Helicobacter pylori, gramnegativ spiralformet bakterie som lever på overflaten av slimhinnen i magesekken og øvre del av tarmen. Bakterien lever mellom foldene til de magesyreproduserende cellene, men klarer seg godt i dette uvennlige miljøet fordi den nøytraliserer magesyren ved hjelp av kraftig produksjon av enzymet urease. Bakterien vokser langsomt og krever en spesiell mikroaerob atmosfære for å vokse. Den ble påvist ved mikroskopi for over 50 år siden, men ble første gang dyrket i 1983.

Denne bakterien koloniserer store deler av befolkningen; ca. 30–40 % i Norge er bærere. Forekomsten av Helicobacter pylori er høyest i befolkningsgrupper med lav sosioøkonomisk status (...)

På grunn av sammenhengen mellom Helicobacter pylori og magekatarr og -sår behandles disse sykdommene i dag med antibiotika (amoxicillin, metronidazol og vismut, eventuelt klaritromycin) kombinert med syrehemmende medikamenter. Behandlingen har vanligvis god effekt, med en viss sannsynlighet for at infeksjonen/plagene gjenoppstår. Kilde: Store norske leksikon.)

What about M.E.? (Hva med rettsmedisinerne?)
bostonherald.com 2.5.2011
M.E.: Lack of funds may thwart homicide cases (Rettsmedisinere (ME): Mangler finansiering som kan oppklare drapssaker)

Murders could go undetected or unsolved due to rushed or missed autopsies without an infusion of hundreds of thousands of dollars to the state’s coroners, the long-troubled Office of the Chief Medical Examiner is warning state leaders.

Despite the budget crunch, the Patrick administration is planning two new regional morgues, even as one built three years ago remains idle due to a lack of funds.

In a letter to Senate President Therese Murray and House Speaker Robert DeLeo hoping to beef up his budget, Dr. Henry M. Nields — hired by Gov. Deval Patrick to turn around the long-troubled office in 2007 — said if he can’t at least replace three recently retired coroners, “unsuspected internal injuries will go undetected, undiagnosed medical conditions will go undetected, and findings which would determine the manner of death, including homicides, will go undetected ... Only the hiring of additional medical examiners will address this matter.” (...)

Call for fewer autopsies to be carried out
heraldscotland.com 5.4.2011
CALLS have been made for a review over the “unnecessary” dissection of dead bodies in Scotland as experts revealed thousands of surgical autopsies are needlessly carried out every year.

Official data obtained by The Herald shows a wide disparity across Scotland over the use of non-invasive external examinations.

Experts and campaigners say the figures show that thous- ands bodies have been unnecessarily dissected in autopsy examinations when an external examination was all that was needed.

Professor Derrick Pounder, the head of the Centre for Forensic and Legal Medicine at the University of Dundee, is among those who are seeking changes saying that apart from “the issues of ethics and human rights” and the potential for delays in funerals, it puts a greater burden on the budgets and time of coroner services.

The data reveals that the use of the non-invasive “view and grant” external examinations of sudden unexplained deaths between 2006 and 2010 varies depending on where you live. (...)

Flickan kan ha dött av morfin
dagensmedicin.se 24.3.2011
Den norske exeperten Jørg Mørland tror inte att den lilla flickan levde när hon fick de mycket höga tiopentaldoserna. Däremot kan hon mycket väl ha dött av en medveten morfinförgiftning. (...)

Enligt Jørg Mørland hade flickan en koncentration av 2 000 mikrogram tiopental per gram lårblod vid den tidpunkt då provet togs. En dödlig dos för ett litet barn är cirka 130 mikrogram och uppåt.

Enligt Jørg Mørland är det dock omöjligt att säga huruvida flickan levde eller inte när tiopentalet gavs. Själv är han tveksam. ”Enligt den sakkunniges uppfattning råder det tvivel om barnet levde vid tidpunkten då tiopental gavs”, skriver han. (...)

– Et lik lyver ikke
nrk.no 2.3.2011
"På jobb med døden" Arne 02.03.11 (...)

Obduksjon kan skje uten å åpne kroppen
vg.no 2.3.2011
(VG Nett) Engelske forskere kan ha funnet en ny måte å fastslå dødsårsaker gjennom CT-skanning.

Mens patologer gjerne må åpne store deler av kroppen for å undersøke mulige dødsårsaker hos avdøde, kan ny teknikk endre hele obduksjonsprosessen, skriver BBC.

Teknikken som er utviklet av et forskerteam ved universitetet i Leicester, går ut på at man gjør et lite snitt i halsen på den avdøde, deretter skannes kroppen. (...)

Uenig i metoden
- Jeg synes denne metoden høres heller dyr ut, sier patolog ved Oslo universitetssykehus, Hans Scott, som påpeker at den opprinnelige metoden lever i beste velgående.

- Vi bruker fortsatt den gamle metoden, og jeg tror ikke den nye vil erstatte den med det første. CT- skanning tar for det første lang tid, dessuten er det dyrt utstyr, mener han.

Scott forteller at lignende metoder allerede er brukt i Norge blant rettmedisinerne.

- Jeg har hørt de har brukt såkalt virtual autopsy på brannlik, for å kunne rekonstruere likene. Men jeg tillater meg å tvile på at det vil bli vanlig hos oss, sier han. (...)

New non-surgical autopsy technique set to revolutionise post-mortem practice
24dash.com 1.3.2011 (Published by University of Leicester Press Office for University of Leicester in Education and also in Central Government)
A new non-surgical post-mortem technique that has the potential to revolutionise the way autopsies are conducted around the world has been pioneered by forensic pathologists and radiologists at the University of Leicester in collaboration with the University Hospitals of Leicester NHS Trust.

The technique developed by a team in the East Midlands Forensic Pathology Unit, at the University of Leicester, has been published today (1 March) in International Journal of Legal Medicine. This paper presents the development of the methodology and protocol for this technique from independent research commissioned by the National Institute for Health Research (NIHR).

The study has taken another step towards a minimally invasive autopsy for natural and unnatural deaths, for either single cases or mass fatalities. It could also potentially allay qualms from certain faith groups that object to autopsies.

Professor Guy Rutty, Chief Forensic Pathologist to the East Midlands Forensic Pathology Unit, which is part of the Department of Cancer Studies and Molecular Medicine, University of Leicester, said the pilot study had demonstrated the potential of the technique to change the future of post-mortem procedures. (...)

- Uheldig at obduksjonen ikke gir et klart svart
dagbladet.no 23.2.2011
Nå setter Ellen Uglands nærmeste sin lit til politiet.

(Dagbladet): I kveld har de nærmeste pårørende til avdøde Ellen Ugland kommet med en reaksjon på den fullstendige obuksjonsrapporten, som politiet i Asker og Bærum la fram tidligere i dag.

Det var 6. desember i fjor at den 57 år gamle enken etter skipsreder og milliardær Johan Jørgen Ugland ble funnet død i sin leilighet på Lysaker Brygge i Bærum. (...)

Scientists hope 'molecular autopsy' explains puzzling death
sacbee.com 6.2.2011
When Richie Quake, a 19-year-old engineering student, was found dead in his bed in Yardley, Pa.,, his family was devastated. But when a conventional autopsy of the apparently healthy young man offered no answers, his parents were gripped by another medical concern: Could a silent but deadly condition be hiding in other members of the family?

Today, scientists at the Stanford School of Medicine are on a quest to find out, searching samples of Richie's tissue for genetic clues that might explain why the young man's heart suddenly stopped.

The "molecular autopsy" is believed the first time that whole-genome sequencing has been used to seek a cause of death, although the Stanford team has used more focused genetic scans to investigate 17 other sudden unexplained deaths. (...)

Doctor Uses Pig Brain In Ryan Widmer Trial
local12.com 10.2.2011
Ryan Widmer's defense team resumed its case this afternoon.

An expert witness for the defense, says the Warren County Coroner did not do an adequate autopsy of Sarah Widmer's body.

The expert even demonstrated how a brain autopsy should have been done, using the brain of a pig.

Doctor Michael Balco claims the coroner did use enough brain tissue to determine if Sarah had an underlying medical condition. He also testified the brain autopsy was done too soon.

The defense has already called eight witnesses to claim Ryan and Sarah Widmer had a happy marriage. They also told jurors Sarah Widmer had strange sleep habits.

Ryan Widmer is accused of drowning his wife in their home in Hamilton Township in 2008. Widmer's attorneys claim Sarah drowned after she fell asleep in the tub. (...)

Victim's family: Do autopsies on all who die alone
nzherald.co.nz 5.2.2011
The family of an elderly woman murdered in her home want mandatory post-mortem examinations carried out on people found dead alone, after her killer almost got away with it.

Wayne John Reid, 59, was jailed for 10 years when he appeared in the High Court at Auckland yesterday. (...)

He arranged Mrs Campbell's body to look as if she had died of natural causes. (...)

Mrs Campbell's daughter, Jacqueline Campbell, told the court that police told her that someone had come forward with information, just hours before her mother's funeral.

"I felt like someone was playing a cruel, sick joke," she said in her victim impact statement.

She said people found dead on their own should undergo a mandatory autopsy. (...)

Province tightens standards for autopsy doctors
calgaryherald.com 4.2.2011

Changes to licensing requirements will soon leave a Calgary pathologist unqualified to do the job in Alberta with his current credentials.

Although Dr. Michael Belenky had proper qualifications in 2008 when he was hired as assistant chief medical examiner, new standards for foreign-trained specialists that take effect March 1 will no longer recognize some of his training from outside Canada. (...)

Flawed Autopsies Send Two Innocent Men To Jail (Feil ved obduksjoner sendte to uskyldige menn i fengsel)
npr.org 1.2.2011
(...) Levon Brooks and Kennedy Brewer are Mississippi men who spent a combined 30 years in prison for crimes they didn't commit. They were separately charged with sexually assaulting and murdering two 3-year-old girls — in two separate crimes — two years apart.

The pathologist who conducted both autopsies said he suspected the girls had been bitten. The forensic dentist who testified in both trials said the teeth marks found on both girls matched that of Brooks and Brewer.

After an investigations led by the Mississippi Innocence Project, Brooks and Brewer were exonerated through DNA evidence in 2008. The lab that cleared the men also generated a DNA profile of a new suspect – Justin Albert Johnson. He confessed to both crimes and is currently awaiting trial. (...)

This video is part of our series Post Mortem: Death Investigation in America, a partnership with ProPublica and PBS Frontline. (...)

Post Mortem
Death Investigation in America
How to Investigate Coroners and Medical Examiners
propublica.org 2.2.2011
Reporters covering the criminal justice system rarely look at coroners or medical examiners -- instead we focus on cops and prosecutors and defense attorneys and defendants.

I began to look more closely at the Tyvek-clad doctors who staff America's morgues when I started finding cases in which they made repeated errors, or failed to document obvious injuries or reached conclusions challenged by their peers.

The coroner or medical examiner in your area may merit the type of examination that could lead to stories.

Here are a few things I'd encourage you to scope out: (...)

Post Mortem
Death Investigation in America
Second Chances Underscore Flaws in Death Investigations
propublica.org 1.2.2011
Watch Frontline's documentary produced in conjunction with this story. And listen to NPR's All Things Considered for more on this story.

Chris Reynolds vividly remembers his first encounter with the work of forensic pathologist Dr. Thomas Gill.

It was 2001. Reynolds, a Santa Rosa private investigator, was hired by a Sonoma County man accused of killing his wife. Gill, who conducted the wife's autopsy, was the prosecution's key witness, having determined the death was a "textbook" case of suffocation.

Reynolds' client's prospects looked grim. But when Reynolds dug into Gill's background, he unspooled a history in which Gill landed post after post despite a lengthening trail of errors and, in one instance, drinking on the job.

Gill had been forced out of a teaching position at an Oregon university, and then fired for inaccurate findings and alcohol abuse by the coroner in Indianapolis, Reynolds discovered. Demoted for poor performance as a fellow for the Los Angeles County Coroner, he resurfaced at a private autopsy company in Northern California.

Reynolds learned that Gill had missed key evidence in the Sonoma County case and that he had been coached by prosecutors to downplay his past, prompting the dismissal of the murder charge.

Yet, in the decade since, Gill has continued to do thousands of autopsies and to serve as an expert witness in criminal cases. He landed a job as the No. 2 forensic pathologist in Kansas City, Mo., where his work again drew fire, and then returned to Forensic Medical Group Inc., the Fairfield firm that handled the case investigated by Reynolds. (...)

Frontline takes on autopsies
vancouversun.com 1.2.2011
"When I was treating live patients, I spoke with them," Dr. Marcella Fierro, one of the U.S.'s leading forensic pathologists says in Post Mortem, tonight's PBS Frontline expose of so-called "death investigations" throughout North America. "And when I have dead patients, I talk to them, too."

Frontline's Lowell Bergman says, "But they don't talk back."

They talk back through the science of forensic pathology, she replies.

And yet ... as the harrowing, eye-opening Post Mortem shows, miscarriages of justice such as the case of disgraced former Ontario pathologist Charles Smith, a pediatric forensic specialist once considered the dean of his profession, happen more often than you think.

Post Mortem shows that, in case after case, errors by coroners and forensic pathologists have caused innocent people to be convicted of crimes they didn't commit and, just as troubling, allow guilty perpetrators to go undetected. (PBS -9 p.m.) (...)

Mom's conviction for killing baby could be overturned
montrealgazette.com 31.1.2011

TORONTO — A Toronto woman who was sent to prison for 14 years for killing her baby, based largely on the testimony of disgraced Ontario forensic pathologist Charles Smith, will most likely have her conviction overturned next week. (...)

But the star witness for the Crown prosecution was Dr. Charles Smith, who at the time, was the head of the pediatric forensic unit at Toronto's Hospital for Sick Children.
Smith testified his autopsy concluded that Wynne had died of "asphyxia," either through smothering or strangulation. This supported the Crown's theory that Marquardt was an inexperienced, young mother who was having relationship problems and took it out on her son.

Smith also testified the defence's theory that Wynne, who was epileptic, may have died from a seizure or other natural causes, was not credible.

He also testified it was only a "minor inconvenience" that Wynne's major organs, including his liver, kidneys and heart valves, had been donated prior to the autopsy when they may have been instrumental in determining the cause of death.

A 2008 review of the autopsy found Smith's conclusions on the cause of death were not evidence-based. (...)

Sviktende helsehjelp førte til selvmord
aftenposten.no 14.1.2011
Fra 2001 til 2009 har Norsk Pasientskadeerstatning betalt ut over 83 millioner kroner i tilsammen 168 saker som gjelder psykisk helsevern. Tilsammen er 596 saker behandlet. Nesten halvparten av sakene hvor det ble gitt medhold, dreier seg om selvmord eller selvmordsforsøk. Gjennomgangen Norsk Pasientskadeerstatning har gjort, viser at 55 selvmord og 22 selvmordsforsøk skyldes svikt ved helsehjelpen. (NTB)

Antall innmeldte selvmord nær firedoblet
vg.no 12.1.2011
Antall selvmord som ble innrapportert fra psykisk helsevern gikk opp fra 31 i 2001 til 118 i 2009. Helsetilsynet tror dette skyldes bedre rapportering, men at det fortsatt kan være mørketall.

Økningen i rapporterte selvmord kommer fram i en rapport hvor Helsetilsynet tar for seg uønskede hendelser i psykisk helsevern gjennom ni år.

Tilsynet tar den kraftige økningen som et tegn på at psykisk helsevern er blitt bedre til å melde inn selvmord. Samtidig pekes det på at det er vanskelig å anslå hvor stor underrapporteringen er. (...)

Meldesentralen – meldinger om uønskede hendelser rapportert fra psykisk helsevern
helsetilsynet.no 12.1.2011
Rapport fra Helsetilsynet 1/2011
Denne rapporten beskriver meldinger om uønskede hendelser som har skjedd pasienter under behandling i psykisk helsevern, og som har vært rapportert til tilsynsmyndigheten i tidsperioden 2001-2009: (...)

•Nesten halvparten (45 prosent) av meldingene fra psykisk helsevern (2008-2009) gjelder unaturlig dødsfall. De fleste meldingene om unaturlig dødsfall gjelder tilfeller av selvmord eller overdose.

•Litt over halvparten av meldingene gjelder kvinnelige pasienter. To tredeler av meldingene gjelder pasienter som er mellom 16 og 44 år gamle. (...)

Last ned rapporten (pdf)
Summary in English
Čoahkkáigeassu (...)

3.3 Mange meldinger fra psykisk helsevern gjelder selvmord ved henging og kvelning
Det er rapportert selvmord og selvmordsforsøk ved blant annet henging og kvelning, gift (narkotika, alkohol, medikamenter og andre typer gift), sprang fra høyt sted og drukning (se tabell 3).

I mange meldte tilfeller av selvmord er dødsmåten ukjent. Den hyppigste kjente dødsmåten ved selvmord var henging og kvelning (28 prosent av meldinger om selvmord). Denne andelen er høyere enn andelen for alle tilfeller av selvmord i Norge. I følge Statistisk sentralbyrås dødsårsaksstatistikk, var ti prosent
av alle dødsfall på grunn av selvmord i 2008 ved henging og kvelning3. Den nest hyppigste dødsmåten i meldinger om selvmord fra psykisk helsevern er gift. Med tanke på det selvmordsforebyggende arbeidet i psykisk helsevern, er denne informasjonen av betydning.

3.4 Antall meldinger om selvmord har økt, men hvor stor er underrapportering?
Antall meldinger om selvmord har økt fra 31 i 2001 til 118 i 2009 (se tabell 4). Denne økningen tyder på at psykisk helsevern er blitt bedre til å melde tilfeller
av selvmord.
Men vi vet ikke hvor stor underrapporteringen er. Var det noen tilfeller av selvmord som ikke ble rapportert, og i så fall hvor mange? Som nevnt tidligere,
skal alle tilfeller av selvmord for pasienter som er under behandling i psykisk helsevern rapporteres til Helsetilsynet i fylket. Disse hendelsene må også meldes til politiet.

I 2008 skjedde det 96 tilfeller av selvmord blant pasienter under behandling i psykisk helsevern som ble rapportert til Meldesentralen. I følge SSBs dødsårsaksstatistikk var det 505 dødsfall på grunn av selvmord i 2008.

Det er vanskelig å bruke disse tallene for å estimere underrapportering fordi:

• Vi vet ikke hvor mange tilfeller av selvmord som gjelder personer under behandling i psykisk helsevern.

• Av pasienter under behandling er det til enhver tid mange pasienter som er på permisjon.

• Mange pasienter får poliklinisk behandling, og de kan ha lange opphold mellom konsultasjonene. Hvis de begår selvmord, er det ikke alltid virksomheten får vite om det, og det kan være usikkerhet om hendelsen er meldepliktig eller ikke.

• Resultatet av politietterforskning og obduksjon er ikke alltid tilgjengelig når meldingen skrives. Dette betyr at meldinger som mangler informasjon om dødsårsaken kan gjelde tilfeller av selvmord, uten at dette er kjent for melderen. (...)

3.6 Nesten halvparten av meldingene gjelder unaturlig dødsfall
Som nevnt, skal alle dødsfall som skyldes selvmord mens en pasient er under psykisk helsevern meldes. Resultatet av dette er at mange meldinger fra psykisk helsevern er meldinger om unaturlig dødsfall.

Nesten halvparten av meldingene som ble registrert i 2008 og 2009 var meldinger om unaturlig dødsfall (313 meldinger av 698: 45 prosent). Andel meldinger om unaturlig dødsfall har stadig økt de siste årene, fra 16 prosent i 2001 til 45 prosent i 2008–2009 (se tabell 4 og figur 4).

De fleste meldingene om unaturlig dødsfall er tilfeller av selvpåførte skader: selvmord eller overdose (692 av 854: 81 prosent av meldinger om dødsfall). Det er få meldinger om unaturlig dødsfall på grunn av skader som ikke var selvpåførte: kun 54 tilfeller (6 prosent av alle meldinger om unaturlig dødsfall). Over halvparten av disse (29 meldinger) var på grunn av somatisk sykdom (se tabell 2). (...)

Michael Jacksons lege stilles for retten
aftenposten.no 12.1.2011
Poplegenden Michael Jacksons personlige lege, Conrad Murray, blir stilt for retten for uaktsomt drap på den berømte sangeren.

Dommer Michael Pastor besluttet tirsdag etter seks dager med bevisførsel at det er lagt fram tilstrekkelig bevis til at han kan tiltales for uaktsomt drap.

Påtalemyndigheten la fram bevismateriale som tyder på at Murrays måte å behandle Jackson på avvek strekt fra vanlig medisinsk praksis.

Jackson døde i juni 2009 av en overdose sterk anestesimedisin som gis intravenøst og normalt bare i forbindelse med operasjoner på sykehus. (...)

80,000 too many postmortems carried out each year, say researchers
mirror.co.uk 4.1.2011
Too many unnecessary postmortems are costing the country more than £8million a year.

As many as 80,000 dissections do not need to be carried out as most deaths are natural, University of Dundee researchers found.

Coroners should abandon “production line” autopsies and order external examinations instead, they wrote in the Journal of the Royal Society of Medicine. (...)

Medisinstudenter måtte obdusere lærer
tv2nyhetene.no 17.12.2010
En gruppe studenter ved Karolinska institutet fikk seg et sjokk da de skulle være med på sin første obduksjon. Kroppen på bordet var deres avdøde lærer.

Ingen av studentene fikk seg til å si ifra der og da, og lot obdusenten sette i gang med arbeidet.

– Den første obduksjonen er veldig følsom, og vi obduserte noen vi kjente! sier en student nyhetsbyrået TT har snakket med.

Flere av studentene sier de har tenkt mye på hendelsen i etterkant, og lurt på om det var riktig at de skulle utsettes for noe sånt.
– Jeg føler umiddelbart at det er noe i rutinene som svikter litt, sier en av studentene.

Leder Maria Ehlin Kolk i Medicine Studerandes Förbund (MSF) er selv legestudent ved universitetet i Umeå. Hun mener hendelsen er svært uheldig. (©NTB)

- Døde av medisinsk kvelning
vg.no 11.12.2010
(VG Nett) Milliardærenken Ellen Ugland (57) skal ha dødd av oksygenmangel til hjernen, hjertestans og stengte luftveier.

Det skal være konklusjonen i den foreløpige obduksjonsrapporten, får VG opplyst. (...)

Etter det VG erfarer, skal rettsmedisinerne foreløpig ha konkludert med at 57-åringen trolig falt om i gangen etter å ha fått et hjerteinfarkt. (...)

Anatomiprofessor Per Holck, som understreker at han kun kjenner saken fra media, sier at det ikke er noen sammenheng mellom hjerteinfarkt og manglende oksygentilførsel.

- Stengte luftveier fører til kvelning, og det gir helt andre funn under en obduksjon enn de man finner ved hjertestans, sier professoren. (...)

CT Could Stand in for Full Autopsy in Some Cases
medpagetoday.com 22.10.2010
A minimally invasive post-mortem examination using CT scans, CT angiography, and biopsies may serve as an alternative to traditional autopsy in certain cases, a small study found.

The radiologic approach correctly identified the cause of death in 18 of 20 bodies for which circumstances indicated a natural death, Stephan Bolliger, MD, of the University of Bern in Switzerland, and colleagues reported in the November issue of the American Journal of Roentgenology. (...)

(Anm: Postmortem Imaging-Guided Biopsy as an Adjuvant to Minimally Invasive Autopsy With CT and Postmortem Angiography: A Feasibility Study. AJR 2010; 195:1051-1056.)

Have we heeded the lessons from Shipman?
BMJ 2010; 341:c5711 (18 October)
The £21m Shipman inquiry recommended fundamental changes to the system that allowed a family doctor to kill undetected for more than 20 years. Ten years on, Clare Dyer investigates what progress has been made

Harold “Fred” Shipman was a popular general practitioner (GP) who practised for more than 20 years in Hyde, Greater Manchester. To his patients, there seemed nothing to mark him out from other family doctors in the town. People trust doctors and they trusted him. It took more than two decades to unmask him as the United Kingdom’s most prolific serial killer.

In January 2000 he was convicted of murdering 15 of his patients. A four year inquiry chaired by the appeal court judge Dame Janet Smith concluded that the death toll was probably more than 200 between 1971 and 1998. Mostly elderly women but nowhere near death, they were killed in their homes or in his surgery with a large shot of diamorphine. “None of your victims,” Mr Justice Forbes told him when he sentenced him to life imprisonment, “realised that yours was not a healing touch. None of them knew that in truth you had brought her death, death which was disguised as the caring attention of a good doctor.” (...)

Lack of action
Many of her key reforms have still not been implemented or have been watered down. Two of the most important—an independent adjudicator to decide doctors’ fitness to practise and reform of the archaic coroners’ system—have been enshrined in legislation and almost made it to the finishing line. But with a change of government in May and swingeing spending cuts to tackle the UK’s huge budget deficit, they were put on hold.

Her fourth report, on the regulation of controlled of drugs, was implemented relatively quickly, but only in part, and Dame Janet now doubts whether that section of her inquiry was worth while. She looked only at preventing health professionals from obtaining drugs illicitly and now thinks a broader based investigation might have prevented the death of David Gray, who was mistakenly injected with 100 mg of morphine by Daniel Ubani, an out of hours locum doctor from Germany. (...)

Autopsy: Ex-Olympian Pettigrew committed suicide
sfgate.com 13.10.2010
(AP) -- An autopsy report says former Olympic sprinter and North Carolina assistant track coach Antonio Pettigrew committed suicide by overdosing on a drug common to sleeping pills.

An autopsy report released Wednesday by the state medical examiner's office said the cause of death was diphenhydramine (dy-fen-HY'-drah-meen) toxicity.

Another report rules the case a suicide and the likely toxic agent as the sleep aid Unisom, which the National Institutes of Health says contains diphenhydramine.(...)

Parents sue NYC over handling of son's brain
google.com/hostednews/ap/article 3.10.2010
NEW YORK — A Staten Island couple are suing New York City after learning that their dead son's brain was on display at a city morgue.
Jesse Shipley was 17 when he died in a car crash in 2005.

Andre and Korisha Shipley say they had no idea his brain was removed during an autopsy until some of the teen's classmates at Port Richmond High School spotted it floating in a jar on a field trip.

After the incident, the city returned the brain and the family disinterred their son from a cemetery so they could bury him with the missing organ.

A city doctor said the brain had been kept for additional tests related to the autopsy.

A city attorney says officials are "evaluating our legal options" for resolving the case. (...)

Data Visualization In Medicine
forbes.com 8.9.2010
The field of data visualization is much broader than most people know, and exploring this breadth was one of our primary goals in compiling the projects described in "Beautiful Visualization." In the following excerpt, Anders Persson of Linköping University in Sweden explains how radiological digital imaging methods allow medical practitioners to conduct "virtual autopsies" without the use of a scalpel or any other invasive instrument.

A striking feature of both clinical routine and medical research today is the overwhelming amount of information--particularly, information represented as images. Practitioners are dealing with ever-larger numbers of images (hundreds or thousands rather than dozens) and more complex, higher-dimensional information (vectors or tensors rather than scalar values, arranged in image volumes directly corresponding to the anatomy rather than flat images).

However, doctors typically still use simple two-dimensional devices such as conventional monitors to review this overflow of images, one by one. Future progress will depend on the development of appropriate methods for handling and analyzing the information, as well as making it comprehensible to users. One of the most important issues for the future is the workflow. The entire chain from the acquisition of data until the point at which the clinician receives the diagnostic information must be optimized, and new methods must be validated. (...)

Doctor says he hid suicide note to protect family of Erica Blasberg (Lege sier han skjulte selvmord for å skåne familien til Erica Blasberg)
latimes.com 27.8.2010
Thomas Hess, who found the body of the LPGA Tour player, says he took items to spare her family embarrassment.

The doctor who found the body of 25-year-old professional golfer Erica Blasberg told Nevada investigators he hid a suicide note and pills because he wanted to spare her family embarrassment, according to a court document released Wednesday.

A Henderson police affidavit detailed the hours Blasberg and Dr. Thomas Hess spent together playing golf, watching TV in a casino sports book and in her home in the days before he found her dead May 9 with a plastic bag over her head.

Detectives investigating the golfer's death searched the doctor's Mercedes-Benz, which was parked in Blasberg's driveway, and found a suicide note and Xanax pills obtained in Mexico. (...)

Only 10% of suspicious deaths undergo autopsies
yomiuri.co.jp 17.8.2010
Only 10 percent of suspicious deaths in Japan underwent forensic autopsies in 2009, mainly because the government has failed to convince people of their importance, according to experts. (...)

Government organizations concerned have already moved to reform the nation's system of determining the cause of suspicious deaths, but the problems to be solved are daunting. Defects of the system were illustrated by several recent criminal cases, especially the fatal beating of a junior sumo wrestler in Aichi Prefecture in 2007. In the past year, public attention has been drawn by suspicious deaths in Saitama and Tottori prefectures. (...)

Av respekt for avdøde
B I Bertelsen
Tidsskr Nor Legeforen 2010; 130:1448-9 (12.8.2010)
Anders Svare setter i en kronikk i Tidsskriftet nr. 7/2010 og i et leserinnlegg i nr. 12/2010 spørsmålstegn ved nytten av sykehusobduksjon (1, 2). Hans ubegrunnede mening er at det «skal foreligge en meget god grunn til å skjære i døde mennesker». Svare mener åpenbart at det sjelden er en meget god grunn. Etter mange år som patolog i tett dialog med klinikere finner jeg fortsatt at obduksjonen representerer nyttig kvalitetskontroll. Jeg kan ikke forstå Svare annerledes enn at han finner det verdiløst at behandlende lege og avdødes pårørende mottar informasjon om at: (...)

Redda av nye lunger, hjarte og lever
nrk.no 21.7.2010
Trass i at fleire og fleire seier seg positive til organdonasjon, er ventelista i Noreg lang. Troels Mathisen fekk hjelp.

Over 250 sjuke nordmenn ventar i dag på friske organ. Sjølv om 8 av 10 seier dei er positive til organdonasjon, er ventelista i Noreg lang for dei som treng nye organ for å bli friske. (...)

Autopsies done in only 4% of suicides (Obduksjoner utføres i bare 4 % av selvmord)
yomiuri.co.jp 19.7.2010
Police conducted autopsies in only 4.4 percent of the cases determined to be suicides last year, according to a Yomiuri Shimbun survey.

About half of the 47 police headquarters nationwide responded to the survey. Some of the headquarters did not respond for such reasons as lack of statistics.
This is the first survey to establish the percentage of autopsies conducted on suicide cases in the country.

The finding raises the question of how police were able to decide the cause of death in what were believed to be instances of suicide without conducting thorough medical examinations.

In some cases, the lack of an autopsy might prevent the proper determination by authorities that deceased people could actually have been crime victims instead of suicides. (...)

Animal Autopsies in Gulf Yield a Mystery
nytimes.com 14.7.2010
GAINESVILLE, Fla. — The Kemp’s ridley sea turtle lay belly-up on the metal autopsy table, as pallid as split-pea soup but for the bright orange X spray-painted on its shell, proof that it had been counted as part of the Gulf of Mexico’s continuing “unusual mortality event.” (...)

Despite an obvious suspect, oil, the answer is far from clear. The vast majority of the dead animals that have been found — 1,866 birds, 463 turtles, 59 dolphins and one sperm whale — show no visible signs of oil contamination. Much of the evidence in the turtle cases points, in fact, to shrimping or other commercial fishing, but other suspects include oil fumes, oiled food, the dispersants used to break up the oil or even disease. (...)

Stricter drug safety needed: Ont. coroner's jury
cbc.ca 29.6.2010
Drug safety in Canada needs an arm's-length body that receives no money from pharmaceutical companies to regulate medications, an Ontario coroner's inquest says.

The five-member coroner's jury into the suicide of 18-year-old Sara Carlin of Oakville, Ont., made 16 recommendations, including a national independent drug safety board that reports to Parliament, the creation of a province-wide drug information system, and a provincial suicide prevention program.

The jury concluded that the cause of death was "hanging by ligature while affected by depression, cocaine and ethanol." (...)

Doctor is charged with signing cremation certificates without proper investigations
BMJ 2010;340:c3373 (22 June)
A consultant physician is facing criminal charges of signing cremation certificates without viewing the bodies, examining them, or speaking to the doctors who looked after the patients in their final illness.

Martin Sandler, a former clinical director at Heart of England NHS Foundation Trust, is charged with offences under the Cremation Act 1902.

The indictment charges him with five counts of signing false certificates in individual cases and a sixth count of signing 111 false certificates between 31 December 2005 and 1 June 2008.

Dr Sandler has been suspended from practice for 18 months by the interim orders panel of the General Medical Council. (...)

Ja, vi trenger flere obduksjoner!
Tidsskr Nor Legeforen 2010; 130:1121 (3.6.2010)
Men først må vi patologer skjerpe oss, vi som har mishandlet denne siste legeundersøkelsen på en måte som gjør at Anders Svare i sin kronikk i Tidsskriftet tror at sykehusobduksjoner er til for patologenes skyld (1). (...)

En myte at obduksjoner gir direkte klinisk nytte
Tidsskr Nor Legeforen 2010; 130:1226 (17.6.2010)
I kronikken min om obduksjoner i Tidsskriftet nr. 7/2010 konkluderte jeg med at det – på tross av det patologer stadig hevder- ikke er grunn til å øke frekvensen av ikke-rettslige obduksjoner (1). I nr. 11/2010 var det innlegg fra to som begge mener at obduksjonsfrekvensen bør økes (2, 3).

Både Alfsen og Ellingsen & Mæhlen fremstiller et romantisk scenario der obduksjoner er en viktig kunnskapskilde for klinikere. Et hovedpoeng med kronikken var nettopp å vise at den direkte kliniske nytten av obduksjoner er en myte. Ingen har vist at høy obduksjonsfrekvens gir bedre diagnostikk og behandling. Dessuten er tallrike obduksjonsserier allerede publisert. Klinikere bør heller studere disse. (...)

- Vi må ikke glemme at voksne hender kan være drapsvåpen
vg.no 5.5.2010
REGJERINGSKVARTALET (VG Nett) Når et lite barn dør brått og uventet, har politiet verken plikt til å etterforske dødsfallet eller undersøke stedet der barnet døde.

Politiet har nemlig ikke etterforskningsplikt når friske barn dør med mindre de selv fatter mistanke eller får melding fra helsepersonell eller andre om at dødsfallet kan være mistenkelig.

- Annenhver måned drepes eller mishandles et barn til døde - les mer her!

Det har Stortinget bedt regjeringen om å gjøre noe med, men foreløpig har ikke justisministeren kommet med noe svar. Han har nå pappapermisjon, og derfor er det statssekretær Astri Aas-Hansen (Ap) som forklarer hvorfor den nye loven ikke er på plass. (...)

Trenger vi virkelig flere obduksjoner?
A Svare
Tidsskr Nor Legeforen 2010; 130:756-8 (8.4.2010)
Frekvensen av ikke-rettslige obduksjoner er fallende. Fra patologer hevdes det at dette er en farlig utvikling, og at økt obduksjonsfrekvens er nødvendig for å redusere kliniske feil. I denne kronikken gjennomgås de viktigste argumentene for å øke obduksjonsfrekvensen, og det konkluderes med at det ikke er grunn til å utføre flere ikke-rettslige obduksjoner. (...)

Det er ingen tvil om at de rettslige obduksjonene er av stor samfunnsnytte. Men når det gjelder de ikke-rettslige obduksjonene, skal det etter min mening foreligge en meget god grunn til å skjære i døde mennesker. Samfunnsnytten bør være uomtvistelig. Av de argumentene jeg har nevnt, er det for det første patologenes behov for å utvikle og vedlikeholde kunnskapene som fyller dette kravet. Videre bør obduksjon tilstrebes hvis pasient eller pårørende har uttrykt mistillit til diagnostikk eller behandling, eller etter pårørendes ønske ved uavklarte dødsfall. (...)

Virtual Autopsy at House of Sweden
scienceblogs.com 28.3.2010
Doesn't that title sound weird - like an experimental film? It may help to know that House of Sweden is Sweden's embassy in Washington, DC - a lovely glass building on the Potomac. If you're in the DC area, you should get on their mailing list, because they host interesting science-related panel discussions and receptions. Yesterday, they opened a new exhibit - the Virtual Autopsy Table. It's a touch-screen tabletop that lets you slice into, rotate, and magnify an MRI-based 3D representation of the human body, all with a brush of a hand:

The Virtual Autopsy Table from NorrköpingsVisualiseringscenter on Vimeo. (...)

Livsfarlig
aftenposten.no 27.3.2010
Det er forstemmende å lese Helsetilsynets knusende dom over mangelfullt tilbud til psykisk syke ved Sykehuset Østfold. 11 pasienter begikk selvmord mens de var i behandling. Nå skal det sies at dersom et menneske virkelig vil ta sitt eget liv, så er det ingen som kan forhindre det.

Men det er både alvorlig og trist når det viser seg at sykehuset ikke har gjort sitt ytterste for å forhindre selvmordene. I flere av enkelttilfellene avdekkes både alvorlig svikt i helsetjenesten og klare brudd på loven. En pasient blir henvist til akuttvurdering på grunn av selvmordstanker, men blir ikke innkalt til samtale før etter fem uker. Da var det for sent. (...)

Overdoses extend wait after death
onlineathens.com 1.3.2010
When a county coroner sends a body to the Georgia Bureau of Investigation's Crime Lab, it takes an average of 84 days to determine the cause of death - but if drugs are involved, the time can stretch to six months. (...)

Only some deaths require an autopsy. If a person died of obviously natural causes, an autopsy isn't necessary. (...)

Drakk han alkohol?
Tidsskr Nor Legeforen 2010; 130:356 (25.2.2010)
Norske forskere har funnet ut hvordan man med større sikkerhet kan avdekke hvorvidt alkohol er inntatt før døden. (...)

Brittany Murphy døde av legemidler
nrk.no 4.2.2010
Brittany Murphy ble bare 32 år gammel.

Dødsfallet til den amerikanske skuespilleren Brittany Murphy skyldtes legemidler i kombinasjon med lungebetennelse og jernmangel. (...)

Doctors demand release of postmortem findings on David Kelly
BMJ 2010;340:c577 (29 January)
Lawyers for six doctors seeking an inquest into the death of the weapons inspector David Kelly have written to the Ministry of Justice demanding to see the results of postmortem examinations of his body.

The move follows a decision by Lord Hutton, the senior judge who led the inquiry into Dr Kelly’s death, to lift a previously undisclosed 70 year ban he had imposed on release of the postmortem findings, pictures of the body and other medical evidence. (...)

– Må ta med lik på legevakten
tv2nyhetene.no 14.1.2010
Begravelsesbyråene sliter med å få leger til å fylle ut dødsmeldingen.

Når en person dør her i landet skal det fylles ut en dødsmelding. Dersom dødsfallet har skjedd hjemme er det fastlegen eller en lege fra legevakten som fyller ut en slik dødsmelding. (...)

Byråene hevder de ofte må vente lenge før lege er på stedet, og at dette skaper utfordringer for jobben de skal gjøre. (...)

– Det at man i Oslo og i storbyene i noen tilfeller og kanskje oftere og oftere får beskjed om å ta med seg avdøde til et legekontor eller ned til legevakten hvor en lege da krabber inn i bårebilen for å faktisk bekrefte dødsfallet. Slik kan vi ikke ha det, sier Schee. (...)

Avslører morderen
nrk.no 6.1.2010
Professor Anders Persson ved CMIV prøver å finne ut hva denne mannen døde av. - Det trenger ikke nødvendigvis være kniven som er dødsårsaken, sier Persson. (...)

Professor Anders Persson har ledet arbeidet ved Center of Medical Image Science and Visualization (CMIV) ved Linköpings universitet og Universitetssykehuset i Linköping. Utviklingen innen medisinsk bildeteknologi har gått fort, og Persson har utviklet en egen teknikk for å skape tredimensjonale bilder av kroppens indre.

- Vi bruker forskjellige avbildingsteknikker som magnetresonans (MR), ultralyd og positronemisjonstomografi (PET), forteller Persson.

Se innslaget i Schrödingers katt her (...)

Legen til Michael Jackson tiltales
nrk.no 8.1.2010
Michael Jacksons lege, Conrad Murrey, er tiltalt for overlagt drap.

Ifølge nyhetsbyrået AP vil påtalemyndigheten ta ut tiltale mot Michael Jacksons lege etter popkongens tragiske dødsfall 25. juni. (...)

Nekter obduksjon - men blir ikke hørt
nettavisen.no 5.1.2010
(...) Politiet opplyser imidlertid til Nettavisen at kvinnen blir obdusert, og at det er usikkert når kroppen blir frigitt. Advokaten mener politiet ikke har rett til å obdusere henne.

- For at politiet skal ha rett til å foreta en obduksjon, skal det foreligge en mistanke om en kriminell handling. Foreligger ikke det, har de ikke rett til å obdusere, hevder Nazir. (...)

Brittany a 'bright light that lit the world'
smh.com.au 27.12.2009
(...) Murphy died on Sunday after collapsing at her Hollywood Hills home. An autopsy on Monday was inconclusive. The coroner's office is awaiting results of toxicology and tissue tests before determining an official cause of death. Foul play is not suspected.

A leaked investigator's report, widely published in the press, showed a multitude of drugs were found at the starlet's home, including the anti-seizure medicine Topamax, anti-anxiety medicines Klonopin and Ativan, painkillers hydrocodone and Vicoprofen, and the depression medicine Prozac. There is speculation Murphy became hooked on prescription drugs to cope with a series of painful plastic surgery operations. (...)

Brittany Murphy’s Home Contained Hoard of Prescription Drugs Including Ones that Killed Anna Nicole Smith According to Police; Cause of Death Deferred; Body Moved to Cemetery
peoplemagazinedaily.com 23.12.2009
(...) The cause of death of the actress has been deferred by the Los Angeles County Corner’s Office because of further testing. The final assessment is expected to take four to six weeks.

Brittany was ingesting prescription medication for several days proceeding her death on Sunday morning due to flu-like symptoms according to TMZ’s sources. (...)

Brittany Murphy's death may be just another example of Hollywood's new prescription trend
examiner.com 22.12.2009
Actress Brittany Murphy’s sudden death of cardiac arrest at age 32 this Sunday has left Hollywood stunned. Unfortunately, being stunned is familiar condition for the entertainment industry in the last few years.

For baby-boomers and Generation X-ers, drug-related celebrity deaths were commonplace. Rock music even has the ubiquitous 27 Club that includes 27 year-old legends Jimi Hendrix, Janice Joplin, Jim Morrison and Kurt Cobain, who died of everything from sleeping pill overdoses to suicide committed under the influence of heroin.

But a new generation of celebrity deaths has emerged in light of the booming pharmaceutical industry. According to the Congressional Budget Office’s December 2nd brief Promotional Spending for Prescription Drugs, $20.5 billion was spent by pharmaceutical manufacturers for promotional activities in 2008. The increased visibility of prescription drug advertising on television since the late 1990s has corresponded, directly or indirectly, to recent celebrity deaths.

In late 2006, Anna Nicole Smith’s son, Daniel Smith, fell asleep in his mother’s hospital room and did not wake up. It was reported that Daniel took a lethal combination of methadone, Zoloft and Lexapro. In a tragic turn of events, Daniel’s mother passed away just months later after overdosing on a sedative and multiple benzodiazepines. Although her death was ruled accidental, many suspect her of being suicidal after Daniel’s death. (...)

- Flere fryser i hjel
nettavisen.no 3.12.2009
Leder ved Blåkors Jostein Hågan vet om flere episoder hvor uteliggere har frosset i hjel vinterstid. (...)

- Det er veldig få om ønsker å bo ute når det er iskaldt. Selv om noen av disse personene kan være litt aggressive, mener jeg at man likevel må ha steder som er tilpasset dem, sier Hågan.

Les også: - La han ligge, han fryser ikke i hjel

- Flere fryser i hjel
- Jeg vet om flere episoder hvor folk har frosset i hjel på gata. Gjestene våre på Blå Kors har fortalt til meg om slike hendelser, sier Hågan. (...)

Oppdager ikke norske barnedødsfall
tv2nyhetene.no 23.11.2009
Barnedødsfall som skyldes mishandling oppdages ikke på grunn av sommel fra regjeringen.

Rundt ti barnedødsfall, som skyldes omsorgssvikt eller mishandling, er ikke oppdaget i Norge på grunn av sommel fra regjeringen. Bakgrunnen er at regjeringen i over fire år har lovet å innføre åstedsundersøkelser når små barn dør, uten at det har skjedd. Og nå blir innføringen ytterligere utsatt.

210 plutselige, uventede barnedødsfall
Det startet med at regjeringen nedsatte en arbeidsgruppe med deltakere fra Helsedirektoratet og Riksadvokaten.

Den kom aldri til enighet om hvordan åstedsundersøkelsene skulle organiseres, blant annet på grunn av konflikter om taushetsplikten.

Etter tre år med sommel og byråkrati fikk til og med regjeringens egne folk nok. (...)

Drept med overdose
nrk.no 6.11.2009
43-åringen satte dødlig narkodose på en annen mann på Oslos beste vestkant. Utbyttet var en mobiltelefon og to minibankkort.

Les også: Flere overdoser kan være drap

I en leiligheti i én av Bogstadveiens leilighetsbygg skal 43-åringen ha satt to sprøyter med en blanding av heroin og amfetamin på sitt offer.

Målet skal ha vært å rundstjele offeret.

Nå er gjerningsmannen blant annet tiltalt for drap. (...)

Leder for Norsk Narkotikapolitiforening, Lars Holmen, sa til NRK tidligere i år at de frykter flere overdosedødsfall kan være drap.

– Dette er dessverre en naturlig del av hverdagen til veldig mange som lever i disse miljøene. (...)

Anna Nicole Smith Clown video
primewriter.com 3.11.2009
(...) Born Vickie Lynn Marshall on November 28, 1967 Anna Nicole Smith was pronounced dead on February 8, 2007. Her son, Daniel Smith died on September 10, 2006 while visiting his mother in the hospital room after Anna Nicole had given birth to her daughter, Dannielynn (her name was changed to Dannielynn in memory of Daniel). An autopsy on Daniel Smith showed that he had died due to a combination of Zoloft, Lexapro, and methadone. Those who knew Anna Nicole Smith stated that she was devastated over the loss of her son Daniel and never recovered.

Attorneys for Howard K. Stern state that the clown video of Anna Nicole was staged and that she was simply acting for the camera. However, autopsy records do not lie and it was concluded that when Anna Nicole Smith died she had the following combination of prescription drugs in her body: topiramate, meprobamate, methocarbamol, clonazepam, diazepam (Valium), nordiazepam, lorazepam, and ciprofloxacin. (...)

Drug deaths on decline, suicides up (Dødsfall relatert til narkotiske stoffer går ned, selvmord opp)
post-trib.com 25.10.2009
Porter County has seen fewer drug-related deaths this year compared to last year's record-setting high, according to the Porter County coroner.

However, the county has also seen a huge increase in suicides, more than double last year's rate.

So far, 17 people have died from drugs or alcohol this year, Coroner Victoria Deppe said. That's compared with the 32 people who died from the same causes in 2008. (...)

The numbers for suicides, do not reflect the same improvement, though. So far, 31 people have committed suicide this year, compared with 15 last year. (...)

Ingen vil granske overdosedødsfall
aftenposten.no 10.9.2009
109 personer døde av overdose i 2007 – 65 av dem på grunn av ulovlige, narkotiske stoffer. Og i fjor døde 60 personer av overdose, ifølge statistikk fra KRIPOS. I tillegg gjennomfører helsepersonell hvert år rundt 2000 gjenopplivinger etter overdoser.

I mars i år vedtok et enstemmig bystyre å sette i gang en granskning av overdosedødsfallene i 2006 og 2007. Rusmiddeletaten spurte tre forskningsfirmaer. To av dem sa nei. Senter for rus og avhengighetsforskning, SERAF, kom med et tilbud, men godtok ikke den økonomiske rammen på 500000 kroner. De regner med at undersøkelsene vil koste 1,4 mill. kroner. (...)

Autopsies inconclusive for 3 runners who died during race
bostonherald.com 20.10.2009
DETROIT — Autopsies for the three men who died running Sunday’s Detroit Free Press/Flagstar Marathon are complete, but what caused the deaths remains unclear, the Wayne County Medical Examiner’s Office said Monday.

The office is submitting tissue and blood for further testing, including toxicology, to determine the cause. Results could take several weeks.

"All three cases are pending," investigator Val Knight said. (...)

Forensic doctor reveals secrets of criminal investigation
dw-world.de 14.10.2009
Autopsies are conducted in only five percent of deaths in Germany
Germany's best-known forensic doctor, Michael Tsokos, is called to the crime scene every two or three days. His typical working day involves situations that most of us only know from crime novels. (...)

Virtual Autopsy Table: Death Goes Digital With Multitouch Table (VIDEO)
huffingtonpost.com 7.10.2009
The new Virtual Autopsy Table lets you examine the inside of a human body in 3D -- without the body.

The new educational tool was created by processing high-resolution MRIs and CT scans to create an interactive, 3D image of the inside and outside of a human body.

Using the Virtual Autopsy Table, users can use the touchscreen to "remove specific layers of body" in order to look at the brain, heart, skeleton, and other organs, and even "cut throught the body with a virtual knife," according to the Virtual Autopsy Table demonstration video.

The multitouch table was developed by Norrköping Visualization Centre and the Center for Medical Image Science and Visualization in Sweden. (...)

- Michael var sunn og frisk
kjendis.no 1.10.2009
Ny obduksjonsrapport lekket. (...)

Men bortsett fra dette var Jackson generelt en ganske sunn og frisk 50-åring, viser den nye rapporten.

Han veide 62 kilo, noe som er ansett å være akseptabelt i forhold til høyden hans (1,75 meter), og hjertet hans var sterkt.

Lungene var derimot ødelagt, noe som kunne føre til at han hadde litt vanskelig for å puste. Disse skadene var derimot ikke livstruende, og ifølge den nye rapporten var det de smertestillende medisinene han fikk av sin personlige lege, Conrad Murray, som var den direkte dødsårsaken. (...)

Frekvens av rettslig obduksjon etter dødsfall i veitrafikkulykker
Tidsskr Nor Legeforen 2009; 129:1850-2 (24.9.2009)
(...) Resultater. I perioden døde 249 personer i veitrafikkulykker i de to fylkene. 157 (63 %) ble rettslig obdusert. Den rettslige obduksjonsfrekvensen falt fra 69 % i første femårsperiode til 57 % i den andre. Størst var nedgangen i Nord-Trøndelag der frekvensen falt fra 62 % til 38 %. Førere av motoriserte kjøretøy ble i større grad obdusert enn andre trafikanter, mens døde ved motorsykkelulykker i mindre grad ble obdusert enn omkomne ved personbilulykker og andre typer veitrafikkulykker. (...)

Fortolkning. Reduksjon i obduksjonsfrekvensen og ulikheter i begjæringspraksis mellom politidistriktene kan være begrunnet i økonomiske forhold, ulik oppfatning av betydning av rettslig obduksjon eller ulik tolking av påtaleinstruksen. Det er ukjent om det var viktige forskjeller mellom omkomne som ble rettslig obdusert og dem som ikke ble obdusert. (...)

Anna Nicoles lege advart mot sterke medisiner
vg.no 22.9.2009
Lege: - Kommer til å drepe henne med dette

(VG Nett) Legen til Anna Nicole Smith ble advart mot bruken av sterke smertestillende medisiner like før hun døde av overdose. (...)

Dokumentene LA Times referer til skal være en del av bevismaterialet i etterforskningen av Anna Nicole Smiths personlige leger, psykiater og advokat. Ifølge AP ønsker etterforskerne å kartlegge deres rolle i omstendighetene rundt dødsfallet til Smith. (...)

Death certificate case raising doubts
gosanangelo.com 19.9.2009
(...) When the death certificate arrived, it said his father had died of “cardiac arrest” with contributing cases of “sleep apnea” and “CAD” which stands for coronary artery disease.

Darrell Close’s physician — Thomas Reals — declined to be interviewed on why he signed the death certificate without examining Close’s body. (...)

Medical experts agree that a third of the nation’s deaths had the wrong cause reported on death certificates, although some believe the error rate is more than 50 percent.

Autopsies can help, but the rate at which autopsies are conducted has steadily declined in the United States since World War II. According to mortality records maintained by the Centers for Disease Control and Prevention, only about 8 percent of all those who died in 2005 and 2006 were autopsied. (...)

Lack of autopsies could hide true causes of deaths
venturacountystar.com 19.9.2009
A first-of-its-kind study has found that younger, well-educated and wealthy people are more likely to be autopsied when they die.

More men than women are autopsied. And blacks, Latinos, Asians and Native Americans are more likely to be autopsied than whites. (...)

For example, excluding cases of homicide and suicide that are routinely autopsied, the study found that nearly 10 percent of people who died from ages 45 to 54 received an autopsy, compared to less than 4 percent of people 65 to 74. The rate drops to less than 2 percent for older Americans. (...)

But even looking at only deceased persons who are 60 or older and who were not victims of homicide or suicide, the autopsy rate for blacks and Latinos was about twice as high as that for whites. (...)

Doktoren svarer
morgenbladet.no 18.9.2009
Hvem skal bestemme over kroppen etter døden?

Magne Stendal disputerer med doktorgraden Medisin fra død til liv ved Universitetet i Oslo. – Undertittelen er kraftig kost: «Framstilling og analyse av etiske, historiske, juridiske, kommunikasjonsrelaterte, medisinske, pedagogiske, praksisorienterte, psykologiske, samfunnsmessige og teologiske synspunkt på obduksjon og organdonasjon for transplantasjon». Hvilke av disse aspektene gir mest hodebry i dag? (...)

- Dosen ikke høy nok til å drepe
side2.no 27.8.2009
USAs anestesileger stusser over at Michael Jackson kunne dø av så lite Propofol.
DOSEN AV PROPOFOL burde ikke ha tatt livet av Michael Jackson, mener eksperter.

(SIDE2:) - Det gir ingen mening, sier John Dombrowski, et medlem av American Society of Anesthesiologists.

Han sier at han ikke kan forstå at tallene i obduksjonsrapporten etter Jackson fordi de viser at Jackson fikk i seg altfor lite Propofol il å kunne dø. (...)

Det er blitt antydet at det var en kombinasjon av droger og Jacksons langvarige bruk som forårsaket hjertestans hos artisten. (...)

Diagnostic mystery (Diagnostisk mysterie)
independentmail.com 20.8.2009
Patterns among S.C. death certificates hard to explain

In most of the United States, autopsies tend to rule out heart disease.
But in much of South Carolina, there’s a diagnostic mystery: Autopsies find more deaths from heart disease, not fewer.

A seven-month investigation by the Independent Mail and Scripps Howard News Service reveals a confusing patchwork of data on heart disease and other major causes of death in the Palmetto State. (...)

In Anderson County, the death rate from heart disease among residents who were not autopsied was 21 percent, but 26 percent among the dead who were autopsied. That’s the pattern in 22 of the 46 counties in South Carolina.

“It’s not a simple answer,” said Dr. Brett Woodard, a forensic pathologist at AnMed Medical Center who serves as Anderson’s main medical examiner. “There are a large number of people in our area that just simply do not go to the doctor, ever. And a lot of the time, the first sign of a heart problem is sudden death.” (...)

Death records a confusing patchwork (Dødsstatikker er et forvirrende makkverk)
redding.com 17.8.2009
All too often in California, no one really knows why someone died, particularly if their death is from natural causes.

Assigning cause of death in the state - and across the United States - is frequently flawed by a lack of medical information and clouded by mistaken assumptions. Experts say it's likely that at least a third of the more than 230,000 death certificates issued in California each year are dead wrong. (...)

We might not really know what's killing Americans
tcpalm.com 9.8.2009
We might not really know what’s killing Americans.

More than 2.4 million Americans die each year, and each one has an official cause of death on a death certificate. But medical experts think about one third of them are incorrect or just guesses that cause researchers and family members to look at the wrong health threats.

“I’ve been preaching for years to anyone who will listen that death certificates are worthless,” said Dr. Stephen Geller, former chief of pathology at New York’s Mount Sinai Medical Center.

The problem is fewer people are autopsied after death. The national autopsy rate is 8 percent, according to a Scripps Howard News Service review of 4.9 million deaths in 2005 and 2006.

Florida is one of only five states that autopsy at least 10 percent of the time. (...)

C4 orders more animal autopsies
broadcastnow.co.uk 7.8.2009
Channel 4 has commissioned a second series of animal autopsy show Inside Nature’s Giants - with plans to scrap the lecture hall setting and go on location.

C4 science commissioning editor David Glover has tasked indie Windfall Films with finding dead animals to dissect in their natural setting, with giant squids and a great white shark top of his list.

The first series, which aired last month, featured autopsies on an elephant, a whale, a crocodile and a giraffe. (...)

Likskue
aftenposten.no 5.8.2009
PER EGIL HEGGE - Språket vårt
Ved Michael Jacksons bortgang ble mye sagt, skrevet og sendt. Aftenposten, Dagbladet og VG skrev alle at det ville bli «offentlig likskue » før begravelsen. Ikke særlig forlokkende. Et likskue, liksyn på nynorsk, er definert som besiktigelse av lik på grunn av mistanke om en kriminell handling. Den foretas av fagfolk, oftest patologer. Den er ikke offentlig, i alle fall ikke i den forstand at det er adgang for publikum. I Norge bruker vi faguttrykket obduksjon når medisinere undersøker en avdød med sikte på å fastslå dødsårsaken. Engelsk rett bruker uttrykket inquest om et rettsmøte som ledes av en coroner, en legdommer. Han eller hun skal fastslå om det var en naturlig død og støtter seg til sakkyndige og vitner. Årsaken til at ordet lik skue ble feilaktig brukt i denne sammenhengen, er nok at det i USA er vanlig med viewing, dvs. at avdøde ligger på utstilling, oftest hos begravelsesbyrået. Da kan de som ønsker det, ta avskjed. Evelyn Waughs bitende satire «The Loved One» berører temaet og gir en helt ny dimensjon til uttrykket «et sminket lik».

I noen land ligger offisielle personer på paradeseng før bisettelsen. Om det brukes gjerne det franske lit de parade. (...)

Editorial: Death certificates ... why we die is important to promoting better lives (Leder: Dødsattester: ... Hvorfor vi dør er viktig for å fremme levestandarden)
naplesnews.com 3.8.2009
A Scripps Howard News Service study of 4.9 million cause-of-death records for the years 2005 and 2006 from the national Centers for Disease Control and Prevention revealed a disturbing conclusion: medical experts think about 30 percent of the death diagnoses were either incorrect, fraudulent or just somebody’s wild guess.

That means our knowledge of what’s killing Americans — and more than 2.4 million of us die each year — is not terribly accurate, which greatly complicates the cause of prevention. In particular, heart disease tends to be a catchall cause of death, blamed for 32 percent of deaths in New York state but only 20 percent in Colorado, the state that not coincidentally has the highest rate of autopsies. (...)

Special Report: Autopsies, causes of death unreliable (Spesialrapport: Obduksjoner, dødsårsaker upålitelige)
reporternews.com 1.8.2009
If you have a weak heart, don’t skip a beat in Haskell County.

People who die in Haskell County are 31 percent more likely to die from heart disease than their neighbors an hour’s drive to the south in Taylor County.

At least, that’s what the data says. But medical experts agree that at least a third of the time, the official cause of death is dead wrong.

En rettspatolog fra Texas anslår at minimum 40 prosent av dødsattester er feil — de samme uriktigedata som forskere benytter seg av. (A Texas forensic pathologist estimated more like 40 percent of death certificates are in error at a minimum — the same faulty data researchers tap into.)

“Alle medisinske granskere vet at det grenser til det ubrukelige,” uttalte dr. Vincent Di Maio, medlem av National Association of Medical Examiners Board og lege i San Antonio. (“Medical examiners all know that it borders on useless,” said Dr. Vincent Di Maio, a National Association of Medical Examiners Board member and San Antonio physician.)

An investigation by the Scripps Howard News Service into 4.9 million national death files provided by the Centers for Disease Control and Prevention found a confusing patchwork of data on many of the most common causes of death such as heart disease, stroke and cancer. (...)

Differences in death, autopsies studied (Avvik ved dødsfall, obduksjoner gransket)
reporternews.com 1.8.2009
A first-of-its-kind study has found that younger, well-educated and wealthy people are more likely to be autopsied when they die.

More men than women are autopsied. And blacks, Hispanics, Asians and Native Americans are more likely to be autopsied than whites.

The disparity has a profound effect on how people understand the diseases that run in their families and how medical research is conducted.

The findings from Scripps Howard News Service’s seven-month review of the 4.9 million deaths in the United States in 2005 and 2006 surprised medical experts. (...)

Study finds significant disparities on cause of death in Tennessee
(Studie finner signifikant misforhold for dødsårsak i Tennessee)
commercialappeal.com 27.7.2009
Information often wrong due to low autopsy rates (Informasjon ofte feil grunnet lavt antall obduksjoner)

More than 55,000 people die in Tennessee each year. There is a cause written on each and every Tennessean's death certificate. But medical experts agree that at least a third of the time, that cause is dead wrong.

The Commercial Appeal and Scripps Howard News Service conducted a seven-month investigation into 4.9 million death files provided by the Centers for Disease Control and Prevention. The study found significant disparities in mortality rates for big killers such as heart disease, stroke, and even cancer. These often-irrational variations are found from state to state and among counties within the same state.

Every day, overburdened doctors and coroners routinely stamp "cardiac arrest" or one of a variety of heart diseases onto death certificates for dead people they haven't examined or even seen. Because of funding limitations, Tennessee has one of the nation's lowest rates of autopsy -- the physical examination that usually determines the true causes of death. (...)

Prescription for abuse (Forskrivning for misbruk)
heraldtribune.com 12.7.2009
Latest statistics show need for wide-ranging reassessment

Florida's medical examiners recently released another report that shows another annual increase in the number of prescription-drug overdose deaths.
The report concluded that prescription medicines caused more deaths in 2008 than illicit drugs -- a multi-year trend. (...)

Resultatene ved årets slutt var ikke overraskende: En foreløbig rapport, som dekker de første 6 måneder av 2008, indikerte at de oppadgående trender i substansforårsakede og substansrelaterte dødsfall ville fortsette gjennom året. (The results of the year-end report weren't surprising: An interim report covering the first six months of 2008 indicated that the upward trends in drug-caused and drug-related deaths would continue throughout the entire year.)

Annual increases
In 2005, the Medical Examiners Commission began reporting the drugs discovered in bodies subject to autopsies. The percentage of decedents with at least one drug in their bodies has increased each year -- to 53 percent last year.

"De fleste" (4 924) av de 8 556 substansrelaterte dødsfall i 2008-rapporten, som ble gjennomgått av de statlige medisinske granskerne, påviste mer enn en substans. De medisinske granskerne, som utførte obduksjoner, skriver at ett eller flere reseptbelagte legemidler forårsaket dødsfall hos 2 184 mennesker sist år. (...) ("The vast majority" (4,924) of the 8,556 drug-related deaths studied last year by the state's medical examiners involved the presence of more than one drug, according to the 2008 report. The presence of at least one prescription drug caused the death of 2,184 people last year, in the opinion of medical examiners conducting autopsies.)

Prescribed addiction: 600,000 fall victim (Forskrevet avhengighet: 600 000 blir offer)
livenews.com.au 12.7.2009
An increasing number of Australians are becoming addicted to prescription medication.

The 2007 National Drug Strategy Household Survey shows around 600,000 people use painkillers for non-medicinal purposes.

The survey also showed those aged 20 to 29 are most likely to abuse prescription drugs, including XANAX, VALIUM and ZOLOFT. (...)

The Pharmacy Guild of Australia wants the industry regulated to ensure people cannot access large supplies of the drugs. (...)

RELATED ARTICLES - Rise in babies born to drug mums (...)

Fear Jacko Drug Death Was Like Heath Ledger's (Frykter Jackos død grunnet legemidler var lik Heath Ledgers)
news.sky.com 27.6.2009
A medical charity believes Michael Jackson's death may have been down to a deadly drug cocktail similar to the one taken by Heath Ledger. (...)

Reports say Jackson may have taken three powerful painkillers in a potentially fatal cocktail, including injections of the narcotics Demerol, Dilaudid and Vicodin.

Other drugs linked to the singer include anti-anxiety drugs Xanax and Zoloft, muscle relaxant Soma and anti-depressant Seroxat. (...)

Sister of fall victim wants help to have autopsy done
willcoxrangenews.com 2.6.2009
(...) Fields said that when there is "clear evidence of the cause of death" upon examination, Flores will not perform an autopsy.

"It is his job to determine the cause of death, and he has done that. At this point, if (Madderra) wants an autopsy, it is a civil thing and she will need to have a private autopsy done. If autopsies were done for every death, the county would be broke," Fields said. (...)

Chicken millionaire had heart disease, trial told
thewest.com 28.5.2009
(...) “It is difficult to say . . .there weren’t many injuries or bruises so (there was) possibly not much of a struggle,” Dr McCreath said. She could not say exactly when Mr Cianciosi had died, but it was possible he died on January 3. A toxicology report showed Mr Cianciosi had an antihistamine often used as a sedative in his system and normal levels of the antidepressant paroxetine. (...)

Hvor pålitelig er dødsårsaksstatistikken?
Leder
Tidsskr Nor Legeforen 2009; 129:980 (14.5.2009)
Norge er et relativt homogent og oversiktlig samfunn med de beste forutsetninger for god registrering av epidemiologiske data. Hensiktsmessig bruk av dødsårsaksstatistikk kan forebygge alvorlige hendelser. Er registreringen god nok?

I dette nummer av Tidsskriftet publiseres en artikkel av Ebba Wergeland og medarbeidere om underrapportering av dødelige arbeidsulykker (1). Denne type dødsfall blir ikke bare underrapportert; mange dødsfall som skulle vært registrert som arbeidsulykker i dødsårsaksregisteret er simpelthen ikke registrert. Det viser seg også at det foreligger en betydelig diskrepans mellom dødsårsaksstatistikken fra Folkehelseinstituttet og Arbeidstilsynets egen statistikk. Selve tallene i de to registrene er nokså like, men når man undersøker hvert enkelt tilfelle, er det minst 30 % som bare er registrert ett av stedene (1). (...)

Arbeidsskadedødsfall blir underrapportert
Tidsskr Nor Legeforen 2009; 129:981-6 (14.5.2009)
Bakgrunn. Arbeidstilsynets registrering av arbeidsskadedødsfall har vært ansett som komplett. Denne studien ble iverksatt for å undersøke holdbarheten av dette. (...)

Fortolkning. Arbeidsskadedødsfall utgjør et større problem enn det fremgår av offisiell statistikk. Mangelfull registrering, spesielt av veitrafikkulykker/transportulykker, innebærer fare for å feilbedømme risiko, utviklingstrender og behov for forebygging. (...)

Plugging Holes in the Science of Forensics
NYTIMES.COM 11.5.2009
It was time, the panel of experts said, to put more science in forensic science.

A report in February by a committee of the found “serious problems” with much of the work performed by crime laboratories in the United States. Recent incidents of faulty evideNational Academy of Sciencesnce analysis — including the case of an Oregon lawyer who was arrested by the F.B.I. after the 2004 Madrid terrorist bombings based on fingerprint identification that turned out to be wrong — were just high-profile examples of wider deficiencies, the committee said. Crime labs were overworked, there were few certification programs for investigators and technicians, and the entire field suffered from a lack of oversight. (...)

Coroner fears suicide statistics may be inaccurate
irishtimes.com 5.5.2009
THE DUBLIN City Coroner has expressed concern about the accuracy of suicide statistics, raising fears that the incidence of suicide may be greater than official figures indicate.

Dr Brian Farrell has called on the Central Statistics Office (CSO) to carry out a national survey of coroners’ records to ensure that suicide mortality is properly recorded.

“Our statistics on suicide are probably inaccurate,” said Dr Farrell. “Official statistics show Dublin to have a lower suicide rate than the rest of the country,” he said, referring to a 2007 report. “There must be serious doubt that this is the case. (...)

Pasienter med selvpåført forgiftning i medisinsk avdeling
Tidsskr Nor Legeforen 2009; 129:882-4 (30.4.2009)
(...) Resultater. Forekomsten av sykehusbehandlet selvpåført forgiftning er 100–200 per 100 000 personår. Omkring 1 % dør i forbindelse med innleggelse, de fleste som følge av alvorlige komplikasjoner før innleggelsen. Dødeligheten er sterkt forhøyet 20 år etter utskrivning. (...)

Fortolkning. Helseproblemene ved selvpåført forgiftning er alvorligere enn det som reflekteres i oppfølging og omfanget av forskning. (...)

Forekomsten av selvpåført forgiftning
Når det gjelder pasienter som innlegges i akuttmedisinske avdelinger som følge av selvskading, dreier det seg først og fremst om akutte forgiftninger. Kopjar og medarbeidere fant at ratene for sykehusbehandlede forgiftningspasienter i Norge i 2000–02 var 144 per 100 000 personår for kvinner og 94 for menn (2). I en ny undersøkelse av forgiftninger i Oslo i løpet av ett år (2003–04) var det 3 775 behandlingskontakter (3 025 episoder, noen overflytninger) (3). 1 870 pasienter ble behandlet prehospitalt, 958 på legevakt og 947 i sykehus. Insidensen for sykehusinnlagte var 210 per 100 000 personår for kvinner og 190 for menn.

Blant de sykehusinnlagte kvinnene ble forgiftningen hos 41 % oppfattet som sikkert eller mulig selvmordsforsøk, 33 % som appell, mens 26 % var uhell eller rusrelatert. De tilsvarende tallene for menn var 28 %, 15 % og 57 %. Det er altså en betydelig kjønnsforskjell med hensyn til suicidal intensjon. Når handlingen ble oppfattet som appell, var pasientene vanligvis klar over at de ikke kunne dø av overdosen, eller sørget for å komme raskt til behandling. Den medisinske behandlingen er god, slik at det er få som dør (1,1 %) eller får varige skader (0,6 %) (4). De døde hadde som oftest pådratt seg komplikasjoner før de ble innlagt, slik som hypotermi eller hjertestans. (...)

Kremasjon er populært
nrk.no 15.4.2009
Mangel på gravplasser fører til at uvanlig mange blir kremert i Ålesund. (...)

I Ålesund blir 60 prosent kremert, mot 35 prosent på landsplan. (...)

Universitetene trenger flere lik
aftenposten.no 25.2.2009
Det foretas stadig færre obduksjoner ved norske sykehus, noe som bekymrer universitetene.

Det utføres stadig færre obduksjoner i Norge. Nå slår Universitets- og høyskolerådet alarm, og frykter for kvaliteten på medisinutdanningen. Studentene trenger rett og slett flere lik.

Antallet obduksjoner ved norske sykehus har gått drastisk ned de senere årene. Tidligere hadde Ullevål universitetssykehus omtrent verdens høyeste andel av obduksjoner. På 80-tallet ble det utført rundt 1.400 obduksjoner i året ved Ullevål, mens tallet nå er nede i nærmere 300, skriver Universitas. (...)

Universitetene trenger flere lik
bt.no 25.2.2009
Det utføres stadig færre obduksjoner i Norge. Nå slår Universitets- og høyskolerådet alarm, og frykter for kvaliteten på medisinutdanningen. Studentene trenger rett og slett flere lik. (...)

Norge på overdosetoppen
tv2nyhetene.no 13.2.2009
Ingen andre land i Europa har tilsvarende narkotikaproblem som Norge.
Hvert år dør nesten 300 av overdose bare i Norge. Det er dobbelt så mange som resten av Europa i forhold til folketallet. Mange av dem dør mens de venter i helsekø.

- Når vi har fått en rusmisbruker inn til oss, så er det ikke som for andre pasienter, at vi kan henvise til lege neste dag. Ofte må de vente i flere uker for å få den hjelpen, sier direktør ved Oslo legevakt, Endre Sandvik til TV 2 Nyhetskanalen. (...)

Antipsykosmedicin farlig för dementa
dn.se 9.1.2009
Alzheimersjuka som får antipsykotiska läkemedel som Haldol och Risperdal under lång tid fördubblar risken att dö i förtid. Det visar den första långtidsuppföljningen av de omdiskuterade medlen. (...)

Den brittiska studien publiceras i förtid i dag på webbplatsen för tidskriften Lancet Neurology. (...)

Redan efter ett år sågs en tendens till ökad dödlighet i den grupp som fick behålla de antipsykotiska medlen. Men skillnaden blev allt större ju längre tiden gick. Tre år efter att studien startade var endast 14 procent av patienterna som åt antipsykotiska läkemedel vid liv jämfört med 30 procent av dem som fick placebo. (...)

(Anm: Antipsychotic drugs for dementia: a balancing act. The Lancet Neurology 2009;8(2):125 (February).)

Psykosmedicin ökar risken att dö i förtid
lakemedelsvarlden.se 9.1.2009
Äldre dementa som behandlas med antipsykotisk medicin löper en ökad risk att dö i förtid. Det visar en studie publicerad Lancet.

DEMENS Det är första gången som forskare gjort en längre uppföljning av de antipsykotiska medicinernas effekt på demenssjuka.

I studien ingick 128 patienter som redan behandlades med antipsykotisk medicin till en av två grupper. Hälften fick stå kvar på behandlingen medan den andra hälften fick placebo. Efter tre år, studien gjordes mellan 2001 och 2004, levde 59 procent av de som behandlats med placebo, 30 procent av de som fått psykosmedicinering. (...)

Riskerna med den här behandlingen för äldre är känd sedan tidigare. Det nya med den här studien är att den visat på att det är just psykosmedicineringen som är orsak till överdödligheten, däremot är den för liten för att säga hur stor risken är. (...)

(Anm: The Lancet Neurology, Early Online Publication, 9 January 2009.)

The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial.
Lancet Neurol. 2009 Feb;8(2):151-7. Epub 2009 Jan 8.
(...) The more pronounced differences between groups during periods of follow up longer than 12 months were evident at specific timepoints (24-month survival 46% vs 71%; 36-month survival 30% vs 59%). (...) INTERPRETATION: There is an increased long-term risk of mortality in patients with AD who are prescribed antipsychotic medication; these results further highlight the need to seek less harmful alternatives for the long-term treatment of neuropsychiatric symptoms in these patients. FUNDING: UK Alzheimer's Research Trust. (...)

Döda får trängas på golvet
dagensmedicin.se 9.1.2009
Trängseln på bårhuset vid Centralsjukhuset i Kristianstad är värre än någonsin. De döda får ligga skavfötters och på golvet utanför kylarna. (...)

Bestemmelse av legemidler og rusmidler i hår
Tidsskr Nor Legeforen 2009; 129:36-8 (1.1.2009)
I de senere år har håranalyser fått økende aksept som et viktig supplement til analyser med blod og urin som prøvemedium. Påvisning av legemidler og rusmidler i blod og urin reflekterer som oftest et relativt nylig inntak, mens stoffer i hår i større grad vil kunne avspeile et inntak over tid. Håret vokser ca. 1 cm per måned, og segmentering av hårprøven før analyse kan gi viktig informasjon om tidspunktet for inntak. Håranalyser har en rekke kliniske anvendelsesområder, f.eks. i kontrollsammenheng og ved rettslige obduksjoner. (...)

Society proposes special centers for autopsies (Forening foreslår spesialsentre for obduksjoner)
yomiuri.co.jp 23.12.2008
The Japanese Society of Legal Medicine says it will propose that administrative autopsies should be conducted at government-run institutions in order to reduce the number of suspicious deaths attributed to unknown causes.

The proposal, to be presented to the Health, Labor and Welfare Ministry, the Justice Ministry and other administrative bodies in January, calls for the establishment in each prefecture of medical centers for investigating causes of death and a doubling of the number of medical specialists involved in the process.

The society estimates that at least 120 more medical specialists and 720 more administrative and medical staff will be necessary to implement its proposals.
The society wants to maintain the current parallel use of judicial and administrative autopsies, but says the system needs to be improved. (...)

Sharp drop in autopsy numbers amid fears over organ scandals
theherald.co.uk 11.12.2008
THE number of post-mortem examinations has fallen by more than half in eight years, leading to concern that doctors are being affected by the organ-retention scandals.

Scotland's surgical deaths watchdog yesterday revealed there had been a dramatic drop in autopsies carried out after death under a surgeon's care - from 16% (696) in 1999 to just 6% (179) last year.

Scottish Audit of Surgical Mortality (SASM) believes the drop has been partly caused by the country's organ-retention scandal, which prompted a widespread loss of public confidence in the procedure. (...)

Survey: Autopsies mystery to most families (Undersøkelse: Obduksjoner et mysterium for de fleste familier)
yomiuri.co.jp 5.12.2008
About 70 percent of people whose family members underwent court-ordered autopsies did not understand why they were done because of insufficient explanations from the police and doctors, according to a survey conducted by the Tokyo University Department of Forensic Medicine.

In addition, about 30 percent of respondents did not fully understand the autopsy results, according to the survey.

Observers point out that the environment surrounding forensic autopsy investigations is underdeveloped, citing the low rate of court-ordered autopsies.

The Diet has begun discussing how to improve the situation and critics are expected to demand that the government improve its treatment of deceased people's families. (...)

Coroner, Parents Disagree on Vaccine's Role in Baby's Death
foxnews.com 5.12.2008
A coroner ruled Friday that a common childhood vaccination was not responsible for a baby's death, but the boy's parents disagree, the Guardian reported Friday.

Eighteen-month-old George Fisher died after doctors vaccinated him with the measles-mumps-rubella vaccine while he was sick, the baby’s parents told the coroner at an inquest this week. (...)

The couple said they later learned that children who have suffered a convulsion are at a higher risk for having another one after getting the MMR shot. They believe the boy suffered a second convulsion after getting the vaccine.

But Crickmore said George's symptoms emerged too soon after receiving the vaccination to be related to it. (...)

Drug deaths skyrocketing in Porter County (Substansrelaterte dødsfall stiger voldsomt i Porter County)
thetimesonline.com 30.11.2008
Twenty-eight people have died of accidental drug overdoses so far this year in Porter County, putting the county on pace to have twice as many deaths as the previous year and triple the number in an average year.

Heroin, cocaine and prescription drugs continue to be the top killers, according to Porter County coroner's office statistics.

Coroner Vicki Deppe said it appears there is more drug use in the county, and that is leading to more deaths. (...)

Drug deaths aren't the only things increasing in 2008 in Porter County. There have been five homicides, an increase from the average of three. Three of the homicides this year have been related to domestic disturbances and the other two have been babies who were harmed.

There have been six drownings, double the number from the previous year. Motor vehicle accident deaths have stayed about the same and suicides are down, something that is surprising because suicides often increase in bad economic times. Deppe said Northwest Indiana was slower to be affected by the failing economy, so perhaps an increase in suicides might, unfortunately, be around the corner. (...)

Autopsy finds plastic in whale
theaustralian.news.com.au 20.11.2008
PIECES of plastic found in a dead whale's stomach in Tasmania has prompted authorities to repeat a warning against marine litter.

Government marine officer Isabel Beasley said a post-mortem on an adult Pygmy Right Whale washed up on Tasmania's east coast found two plastic caps inside its stomach.

The plastic tops were about four centimetres in diameter, reasonably large to be carrying around in the six metre long, baleen whale's stomach, Dr Beasley said. (...)

Cocaine, prescription drugs often found in autopsies
japantimes.co.jp 1.11.2008
(...) The three most frequently occurring drugs found during autopsies around Florida were alcohol, all benzodiazepines and cocaine, according to the statewide report.

Benzodiazepines are among the most commonly prescribed depressant medications in the United States, according to the Center for Substance Abuse Research. Among these drugs are Xanax and Valium. (...)

‘Wonder drug’ played a part in man taking his own life – coroner
thecnj.co.uk 18.10.2008 (Camden News)
A POSTAL driver who was prescribed an anti-depressant “wonder drug” killed himself four weeks later, an inquest heard.

Hampstead-born Ian Fox, 65, died in July after throwing himself in front of a train at Finchley Road Tube station.

He had been prescribed the anti-depressant Citalopram for just one month before taking his life and he had expressed a wish to come off it, complaining of confusion and anxiety.

At his inquest on Thursday, Mr Fox’s wife, Maria Fox, blamed her husband’s sudden death on the drug, and a coroner ruled the “adverse effects” of Citalopram had played a part.

“I felt Citalopram was to blame for my husband’s death,” Mrs Fox told St Pancras Coroner’s Court.

According to medical research, confusion and anxiety are known side effects in around one in every 100 patients, although it has more generally known for its wonder drug qualities in successful treatments.

Mrs Fox, from Edgware, said her husband’s action was completely out of character.

She described how until he began taking Citalopram he had only been suffering from mild depression, brought on by retirement from his Royal Mail job and a foot injury.

Coroner Dr Andrew Reid said he accepted that Mr Fox had jumped in front of the train, adding: “I’m satisfied he did so while the balance of his mind was disturbed while suffering the adverse effects of Citalopram.” (...)

Virtual Autopsy Photographer Takes 2008 Lennart Nilsson Award
medgadget.com 9.10.2008
This year's Lennart Nilsson Award for scientific photography, yet another prestigious prize administered by Karolinska Institutet, went to Swedish physician Anders Persson, MD, PhD, in recognition "of his innovative techniques for capturing 3-D images inside the human body." When we looked through his pictures on the award's website, we were quite amazed. (...)

Psychiatrist urges more accountable mental health services
abc.net.au 6.10.2008
A Gold Coast psychiatrist says mental health services in Queensland still are not accountable enough.

It is Mental Health Week and the executive director of the Gold Coast Institute of Mental Health has repeated his call for Queensland Health to provide six-monthly reports on key statistics. (...)

Coroner to the stars, Ronald Kornblum, dies at 74
ap.google.com 28.9.2008
LOS ANGELES (AP) — Ronald N. Kornblum, a former Los Angeles County coroner who performed autopsies on such celebrities as John Belushi, Natalie Wood and Truman Capote, has died. He was 74.

Kornblum served eight years as county coroner before resigning in 1990 amid charges of poor management. He died Tuesday at his home in La Canada-Flintridge after a long illness, his family said. (...)

Photo prize for virtual autopsies
blogs.zdnet.com 26.9.2008
Anders Persson, a Swedish radiologist, will receive the 10th Lennart Nilsson Award, one the world’s most prestigious award in scientific and medical photography, on October 28, 2008. Persson received this prize for his innovative techniques for capturing 3-D images inside the human body. ‘These new techniques have proven particularly useful for post-mortem imaging, providing invaluable information for forensic investigation.’ Read more for a selection of scary and spectacular pictures… (...)

Deaths by drugs or drink ‘are now run of the mill’
walesonline.co.uk 19.8.2008
A CORONER who has overseen the spate of apparent suicides in a Welsh community said drug and alcohol deaths had gone from non-existent to “run of the mill” during his time in the role.

Announcing his forthcoming retirement in October after 35 years in the role, Philip Walters, coroner for Bridgend and North Glamorgan, said the rise in such deaths was his biggest concern.

The 69-year-old also dismissed suggestions of a link between the apparent suicides in Bridgend county, where 23 young people appear to have taken their lives since early 2007.

“I think you notice things over time that change considerably and one of them since I started out as coroner is the increase in drug- related deaths,” he said.
“They were non-existent when I started. The first one I did was about 25 years ago when a young girl from Treherbert died sniffing an aerosol can, and that was rare.

“But these days it’s just run of the mill and you get at least one a month. And we are only dealing with the sad cases that result in death, so it’s worrying to think how many people are now taking drugs. (...)

“Overdosing on alcohol, like drugs, is still classed as accidental but natural deaths have increased immensely and the average age has lowered a lot – that has got to be a concern. (...)

Forensic science: Secrets of the case against Crippen
guardian.co.uk 17.8.2008
Personal records of controversial pathologist could shed new light on classic murder trials (...)

Vil gjøre forsøk på henrettet fange
nrk.no 13.8.2008
Forskere ved Rikshospitalet ønsker å gjøre forsøk på en kropp delt opp i 1871 millimetertynne skiver. (...)

Professer Erik Fosse ved Rikshospitalet har nå stanset innkjøpet av datamaterialet, og har bedt Den nasjonale forskningsetiske komité for medisin og helsefag (NEM) om en vurdering. (...)

- Når det gjelder spørsmålet om fritt, informert samtykke er det vanskelig å vite omstendighetene rundt fangens samtykke og om han var innforstått hva han samtykket til, skriver komitéen i sitt tilsvar og fortsetter:

- En dødsdømt fange befinner seg i en ekstrem tvangssituasjon og det kan tenkes at vedkommende vil samtykke til hva som helst for å oppnå et ”siste ønske”. På den annen side har ikke fangen noe å tape da han allerede har tapt alt, nemlig livet. (...)

Autopsy Shocks Medicos
gather.com 9.8.2008
One of the world's oldest living human beings, a woman who lived in The Netherlands, recently died at age 115. Doctors were shocked with the autopsy results: Her brain was healthy when she died. There was no sign of Alzheimer's disease or dementia, two devastating illnesses that until now doctors assumed were inevitable if we lived long enough. (...)

Sharp fall in number of autopsies 'puts patients' lives at risk' (Kraftig fall i antall obduksjoner "setter pasienters liv i fare")
independent.co.uk 3.8.2008
Autopsy numbers have fallen by up to 90 per cent in some areas in recent years, and that is making it harder to spot trends in disease development, misdiagnoses and evidence of substandard care.

Medical errors are picked up in nearly 40 per cent of post-mortem examinations, which offer a vital tool for improving patient care. Health officials then scrutinise death certificates to identify public health priorities. (...)

There are two types of autopsy: those ordered by a coroner for sudden and suspicious deaths, and those in which doctors need consent from bereaved relatives for patients who die in hospital. The current crisis is in the latter group.

Consent autopsies were once carried out on 10 per cent of people who died in hospital. But The Independent on Sunday has discovered that in some areas less than 1 per cent of deaths now result in an autopsy. (...)

The number of autopsies plummeted following the Bristol and Alder Hey organ-retention scandals. But research by the Royal College of Pathologists found the decline is largely due to doctors no longer asking relatives for permission.

Some doctors may not want to risk finding out they did something wrong or could have done better, according to Professor Furness. "The reason to request a post-mortem is to essentially find out if you got it right or not, so it may be easier for some doctors not to find out," he said. (...)

Helsepolitikere tar opp kistesaken
aftenposten.no 2.8.2008
SVs helsepolitiske talsmann, Olav Gunnar Ballo, er overrasket over opplysningene om båretransport. Han vil be helseminister Bjarne Håkon Hanssen stramme opp regelverket. (...)

Ont. introduces guidelines for coroners, pathologists
canada.com 29.7.2008
OTTAWA - Ontario has become the first province to introduce guidelines for coroners and pathologists investigating cases of young people who die of no apparent cause.

The guidelines, which could eventually be adopted nationwide, are designed to give grieving families clear answers to a sudden unexplained death.

They could also point to inherited life-threatening heart defects that can strike surviving family members. (...)

Rapid rise seen in fatal medication errors at home
ap.google.com 28.7.2008
CHICAGO (AP) — Deaths from medication mistakes at home, like actor Heath Ledger's accidental overdose, rose dramatically during the past two decades, an analysis of U.S. death certificates finds. (...)

The findings, based on nearly 50 million U.S. death certificates, are published in Monday's Archives of Internal Medicine. Of those, more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs.

Deaths from medication mistakes at home increased from 1,132 deaths in 1983 to 12,426 in 2004. Adjusted for population growth, that amounts to an increase of more than 700 percent during that time. (...)

"When we see overdoses, we're seeing many more mixed drug overdoses," said Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners and director of autopsies at the University of Michigan in Ann Arbor.

Jentzen said autopsies are much more likely to include toxicology tests today than 25 years ago, which would contribute to finding more fatal medication errors as cause of death.

But Phillips said there were no significant increases in other poisonings like suicidal overdoses or homicides, so more testing doesn't explain the huge increase. The analysis excluded suicides, homicides and deaths related to side effects.

The increase was steepest in death rates from mixing medicine with alcohol or street drugs at home; that death rate climbed from 0.04 per 100,000 people in 1983 to 1.29 per 100,000 people in 2004. (...)

'Forensic medicine experts should handle autopsies'
timesofindia.indiatimes.com 10.6.2008
NEW DELHI: In the Aarushi Talwar murder case, no photographs were taken of the body and of the crime spot by the investigating agency on the first day.

Forensic science experts say taking photographs of the crime spot is crucial to systematic collection of evidence, which can be effectively done only in the presence of forensic experts. Moreover, a forensic medicine expert did not conduct the autopsies of Aarushi, Hemraj and Sandhaya Maini, who according to Noida police was smothered to death, but her post-mortem didn't confirm the same.

An autopsy report gives vital clues about the nature of crime and helps in solving the case. Though all doctors are qualified to perform autopsies, experts say vital clues can be missed by them. “A forensic medicine expert can pick up fine details during autopsy, which can be missed otherwise. The time, cause and manner of death can be identified during autopsy. It is a specialized field,” said Dr Satish Verma, professor of forensic medicine, University College of Medical Sciences (UCMS). (...)

Den aller siste legeundersøkelsen
aftenposten.no 4.6.2008
Obduksjonsfrekvensen ligger på rekordlave 8 prosent. Flaskehalsen er legene, ikke de pårørende. Taperne er vi. (...)

Feilprosenten er stor når det gjelder fastsettelse av dødsårsak. Obduksjon kan gi sikkerhet. En internasjonal studie fra 2002 viste at andelen alvorlige feil ble redusert med 12,4 prosent for hver 10 prosents økning i obduksjonsraten. - Disse tallene viser hvor enormt viktig denne siste legeundersøkelsen er. Legene lærer av sine feil, til nytte for senere pasienter, sier Alfsen. (...)

Hun hevder at den store nedgangen i dag ikke skyldes mangel på patologer, men mangel på begjæringer fra lege om obduksjon når en pasient dør. Nye rutiner har gjort det mer arbeidskrevende for legen å begjære obduksjon.

Samtidig er legenes arbeidsdag blitt et kappløp med tiden.

Etter nye lovforskrifter innført i 2004 skal det ikke utføres obduksjon uten at pårørende er informert om at dette er ønskelig. Legen skal også informere de pårørende om deres rett til å si nei. (...)

Finner dødsårsaken på 20 sekunder
aftenposten.no 24.5.2008
Ny svensk teknikk gjør obduksjonen virtuell.

I fjor ble forskerteamet ved Centrum for medisinsk bildevitenskap og visualisering i Linköping (CMIV) kontaktet av produsentene bak den uhyre populære TV-serien C.S.I., Crime Scene Investigation. (...)

Se bilder og les mer om hvordan metoden fungerer her (...)

Fremgangsmåten skal også være enkel: Når politiet ankommer et åsted, blir den drepte plassert i en sekk, fullt påkledd. Sekken kjøres gjennom apparatet, en computertomograf (CT) og alt blir projisert på veggen. Rettsmedisinerne tar på seg 3D-briller som går igjennom ulike deler, trinn for trinn.

Kroppen snus og vendes på som om den henger i løse luften. Apparatet skanner gjennom de delene av kroppen rettsmedisineren ønsker å se på. (...)

Coroner Urges Care With Use of Anti-Depressants
redorbit.com 24.5.2008
A coroner has again reiterated warnings for careful consultation and monitoring of patients prescribed a type of anti-depressant medication, after an Appleby man took his own life within months of being prescribed it. Coroner Ian Smith held an inquest on Tuesday into the death of Jeremy Reece Fortune, 33, in Nelson. (...)

Läkare varnar för bruna livsmedel
unt.se 11.5.2008
(...) Vissa livsmedel som innehåller så kallade AGE-föreningar kan höja risken för en lång rad kroniska sjukdomar - och bidrar till snabbare åldrande. Läkare slår nu larm om den ökade konsumtionen av brun, söt mat. Livsmedelsverket i Uppsala efterfrågar mer forskning på AGE. (...)

- Dessa restprodukter är svåra att bryta ned för kroppen. De samlas i vävnader och leder till att vävnaden kan försvagas. Elasticiteten i musklerna minskar, senor försvagas och en ökad stelhet i ögonlinsen kan bl a uppstå, berättar Gerhard Wikström, överläkare i kardiologi vid Akademiska sjukhuset i Uppsala.
Restprodukterna upptäcktes under obduktioner och ser ut som en brun "sörja" i vävnader och muskler.

- Det ser äckligt ut, säger Gerhard Wikström. (...)

Levertransplantasjoner helbreder neppe
vg.no 4.5.2008
(VG Nett) En ny norsk studie viser at levertransplantasjoner forlenger livet til pasientene som får det, men at det neppe helbreder dem fullstendig. (...)

Doubling of autopsies urged for unusual cases
yomiuri.co.jp 25.4.2008
The Japanese Society of Legal Medicine plans to propose doubling to 30,000 annually the number of autopsies conducted by medical examiners in the cases of people who are found dead in unusual circumstances.

The figure represents a rise in autopsies conducted from the current 10 percent to 20 percent of deaths whose causes are unknown. (...)

According to the draft proposal, more than 150,000 people are found dead in unusual circumstances every year, with the cause of death not necessarily obvious. The number of unusual deaths has increased sharply in recent years. (...)

Flest danskere dør på venteliste
berlingske.dk 18.4.2008
(...) Hvis du er på venteliste til et nyt organ i Danmark, er dine chancer for at overleve langt dårligere, end hvis du boede i Norge, Sverige eller Finland. (...)

Obese bodies make autopsies a burden
6minutes.com 14.4.2008
(...) “Pathologists and technicians often have difficulty in performing autopsy dissections, as opening body cavities that are encased in many centimetres of adipose tissue is technically difficult and sometimes not possible on standard trolleys or tables,” he writes in the Journal of Forensic and Legal Medicine this week.

“Autopsies have been performed on floors, or with a pathologist leaning from a ladder, or actually standing on the trolley over a body.” (...)

Independence of autopsy questioned
radiofiji.com 7.4.2008
Defence lawyers in the death trial of Tevita Malasebe in which eight policemen are charged with his death this morning questioned the independence of the post mortem examination report. (...)

Autopsies not performed as frequently as many may believe (Obduksjoner ikke utført så ofte som folk tror)
pe.com 25.3.2008
Popular television crime shows may lead people to think that autopsies are common in death investigations.

On the contrary, autopsies were performed in about 16 percent of the deaths the Riverside County Sheriff/Coroner's Bureau investigated in 2006, according to its most recent information. Autopsies were performed even less frequently in San Bernardino County last year -- in about 10 percent of cases. (...)

Of the 1,433 autopsies performed in 2006, about 10 percent of the deaths were ruled homicides, records show. About 4 percent were identified as undetermined. Most were found to be natural deaths. (...)

A soldier's death, a family's fight
indystar.com 16.3.2008
Army probe finds failures in care at Fort Knox unit (...)

The Army pronounced Cassidy's death an accidental overdose. The 31-year-old soldier took too many prescription drugs that, in combination, suppressed his respiratory system. In his system were methadone, the antidepressant citalopram, multiple opiates, a tranquilizer and a hypertension drug. (...)

Stabler lik i hauger
nettavisen.no 11.3.2008
Svensk politi bruker tungt kriminelle til å frakte lik.

PÅFØRT SKADER PÅ LIKENE: Lars Gåre er ansatt i firmaet som transporterer døde personer for politiet. Han innrømmer at han flere ganger har påført skader på de døde på grunn av uforsiktig behandling. (...)

The Vanishing Nonforensic Autopsy
NEJM 2008;358:873-875 (February 28)
(...) The scientific, educational, and public health benefits of the autopsy, though generally acknowledged, remain difficult to quantify. However, autopsy plays a demonstrably important role in confirming or overturning diagnoses entertained by treating physicians. One classic study examined 100 autopsies performed in each of three decades at a Boston teaching hospital to determine the frequency with which autopsy identified missed diagnoses (e.g., the missed aortic dissection) that would have resulted in a change in therapy and might have prolonged survival if identified earlier.³ These errors — categorized as class I errors — were found in approximately 10% of autopsies in all three decades. The authors also found class II errors — missed diagnoses that didn't affect survival but were nonetheless clinically important (e.g., the advanced hepatocellular cancer) — in an additional 12% in each decade. (...)

(Anm: Trends in U.S. Autopsy Rates. NEJM 2008;358:873-875 (February 28).)

Ahus brøt loven:
Obdusert uten samtykke
nrk.no 15.2.2008
Ambulansefolkene ga først ikke Mary Elisabeth Flølo adrenalin på grunn av den pågående ’IV Ja/Nei-studien” var de pålagt å åpne en konvolutt som skulle avgjøre om hun kunne få intravenøse medikamenter under gjenopplivningsforsøket, eller ikke. Konvolutten sa nei.

Mary Elisabeth Flølo, astmapasienten som utløste varslersaken om det såkalte Hjertelotteriet, ble obdusert uten informasjon til de pårørende. Nå tar sykehuset selvkritikk. (...)

Brando's death still a mystery after autopsy
cnn.com 2.2.2008
LOS ANGELES, California (AP) -- An autopsy on the body of Christian Brando did not immediately determine what killed the son of the late actor Marlon Brando, authorities said. (...)

The cause of death was listed as deferred, pending results of toxicology tests that may determine whether Brando had prescription or other drugs in his system and whether a medical condition was involved, Los Angeles County coroner's official Ed Winter said. (...)

The autopsy was requested "based on his past drug history," Los Angeles County coroner's Lt. Fred Corral said Monday. (...)

Suicides, accidental deaths rose in 2007
thetimesonline.com 1.2.2008
More people killed themselves last year in Porter County than in any of the previous dozen years, and the county also saw a sharp increase in accidental deaths, according to the just-released Porter County Coroner's Office 2007 Annual Report. (...)

In addition, 16 people died of accidental overdoses, two less than the previous year but still a huge increase over the past average of eight per year. (...)

- Begikk trolig selvmord
Anna Nicole Smiths sønn begikk mest sannsynlig selvmord, uttalte etterforsker tirsdag.

Doktor Lee Hern, som har etterforsket Daniel Smiths dødsfall, mener 20-åringens død var resultat ev en tilsiktet overdose, melder AP.

Han begrunner dette med at Smiths inntaket av metadon var svært høyt i løpet av kort tid. Samtidig uttalte etterforskeren under høringen i Bahamas tirsdag at han ikke trodde Smith brukte medikamentet ofte. (...)

. Politiet har allerede uttalt at det ikke finnes noe bevis for drap, og undersøkelser finner dette sannsynlig da årsaken til døden var en kombinasjon av ulike medikamenter. Høringen fortsetter onsdag. (...)

Psychiatrist Told to Get Help; Says It's Because She Links SSRIs to Suicide
shortnews.com 28.1.2008
Australia: Dr. Yolande Lucire, a forensic psychiatrist with over three decades of experience in the field, has been reprimanded and ordered to get psychiatric help after a disagreement with the NSW Medical Board professional standards committee.

It stems from a medico-legal case in which her testimony led a judge to say doctors are responsible for violent crimes being committed by a "Ritalin Kids" generation. All Lucire could say was that it "did not relate to patient care."

Lucire suggests that some may question her ability to do her job because of her view that there is a connection between suicide and SSRI antidepressants. She cited a sudden stop in taking ADHD pills for a defendant in the assault and indecency case. (...)

Toxicology Report On Mother Inconclusive
ketv.com 25.1.2008
OMAHA, Neb. -- Toxicology reports released on Thursday provided no new answers as to why an Omaha mother died. (...)

Toxicology reports found no illegal drugs in Browning's system, the report showed, and only a small amount of a prescribed antidepressant drug.

No foul play is suspected.
The acting coroner for Douglas County said it appears Browning died of natural or undetermined causes. (...)

Avlägsnade hjärnan på avlidet barn – anmäls
dagensmedicin.se 22.1.2008
Läkaren godkände att hjärnan på ett avlidet barn togs bort för att undersökas. Föräldrarna chockades svårt när de fick veta och anmäler läkaren på Mälarsjukhuset till Hälso- och sjukvårdens ansvarsnämnd. (...)

Pathologist hid evidence, inquiry hears
nationalpost.com 16.1.2008
Hair Found On Girl; Smith tried to blame police for oversight

TORONTO - Charles Smith, the disgraced forensic pathologist, tried to blame police for disregarding an adult's hair found in the vaginal area of a 21-month-old girl, Jenna, whose mother, Brenda Waudby, was later wrongfully charged with her murder, the Goudge inquiry heard yesterday. (...)

Recreational Drugs FAR Less Likely to Kill You than Prescribed Drugs!
mercola.com (16.1.2008)
Recreational drugs, including cocaine and heroin, are responsible for an estimated 10,000-20,000 American deaths per year [1,2]. While this represents a serious public health problem, it is a "smokescreen" for America's real drug problem. America's "war on drugs" is directed at the wrong enemy. It is obvious that interdiction, stiff mandatory sentences, and more vigorous enforcement of drug laws have failed.

The reason is simple. Cause and effect have been reversed.

The desire to solve problems by taking drugs is a product of our culture. When a child is taught by loving parents that the appropriate response to pain or discomfort is taking a pill, it is obvious that such a child, when faced with the challenges of adolescence, will seek comfort by taking drugs. (...)

Doubt cast on homicide autopsies
canada.com 7.1.2008
Lawyers call for review of senior Ottawa pathologist's work to make sure 'nothing went wrong'

An association of Ottawa defence lawyers is calling for an independent review of all the homicide autopsies handled by a senior forensic pathologist after serious questions about his work were recently raised at a public inquiry. (...)

Cops send alive man for autopsy
timesofindia.indiatimes.com 27.12.2008
PATNA: A man was actually declared dead and sent to the post-mortem room by police when he was actually alive. Abdul Raza - a road-roller driver of the state Public Works Department - was found in a semi-conscious state at Chajjubagh here on Tuesday morning.

“The Khajekalan police informed his family members at home that Raza was dead and his body can be collected from the post-mortem room in Patna Medical College Hospital (PMCH). The news immediately had the family members wailing,” said Hameed Intiaz, a relative. (...)

Forensic pathologist numbers plummet by 15%
yomiuri.co.jp 24.12.2007 (The Yomiuri Shimbun)
Eleven pathologists over the past three years have had their names removed from university lists authorizing them to conduct forensic autopsies, with another 11 due to lose the designation in the near future, according to a survey by the Japanese Society of Legal Medicine. (...)

DA's Death Re-Examined in Tenn.
ap.google.com 14.12.2007
(...) KNOXVILLE, Tenn. (AP) — Knoxville's district attorney was found dead in his pasture in 1992, his breastbone and some of his ribs broken, a hoofprint on the chest of his overalls. Investigators concluded he had been knocked down and trampled to death by his cattle.
Fifteen years later, they appear to have a new theory: It was no barnyard accident at all. (...)

Dossett-Leath, a 59-year-old registered nurse, goes on trial in February in the 2003 slaying of her second husband, David Leath, a retired barber. He was shot to death in the couple's bed. An autopsy found painkillers and antidepressants in his system that had not been prescribed. (...)

Organ harvesting spoiled autopsy, pathologist testifies
theglobeandmail.com 13.12.2007
TORONTO -- Doctors at an Ontario hospital destroyed potentially valuable evidence by harvesting the organs of a two-year-old boy before he could be autopsied in 1993, the Goudge commission was told yesterday. (...)

Donor-treff etter Facebook-jakt
vg.no 10.12.2007
I høst ble det satt i gang en Facebook-aksjon for å finne en stamcelledonor til lymfekreftsyke Mette Tschopp-Fageraas (29). Nå har hun fått hjelp til å komme i gang med sitt livs kamp. (...)

Questions raised about another pathologist
theglobeandmail.com 8.12.2007
TORONTO -- A top Ottawa forensic pathologist - Brian Johnston - was allowed to run the coroner's Eastern Ontario autopsy unit for 13 years after a disturbing record of autopsy mistakes first emerged, the Goudge commission heard yesterday. (...)

Monster that may put flesh on the bones of history
timesonline.co.uk 3.12.2007
The biological secrets of the dinosaurs could soon be glimpsed after the apparent recovery of organic material from a “mummy” unearthed in the United States. (...)

This has allowed scientists to perform a detailed “autopsy” on the animal, and to reconstruct details of its anatomy as never before. The results will be presented on Sunday in Dino Autopsy, a documentary on the National Geographic Channel. (...)

For some cases, CT scans may offer knifeless autopsy option
baltimoresun.com 28.11.2007
More than 4,100 times each year, people who die in accidents, homicides, suicides and unexplained medical events in Maryland are dissected and probed until state medical examiners can match the death to its cause.

In each case, the grim but important work can take hours. And no matter how skilled and caring the practitioner, the autopsies may disfigure the remains and offend the beliefs or sensibilities of families.

Now Maryland researchers say they've demonstrated that computed tomography (CT) scans are nearly as accurate as traditional autopsies in revealing the cause of death. (...)

Forensics Go High-tech With CT Autopsies
sciencedaily.com 28.11.2007
ScienceDaily (Nov. 28, 2007) — Radiologists are investigating the use of computed tomography (CT) as a tool for civilian medical examiners' autopsies in the United States. According to findings presented November 27 at the annual meeting of the Radiological Society of North America, CT autopsy has the potential to replace conventional autopsy in determining the cause of certain accidental deaths. (...)

Forensic pathologists in short supply
northjersey.com 20.11.2007
(...) While hospital pathologists can earn more than $200,000 a year performing autopsies on natural deaths, a forensic pathologists can make less than $100,000 a year even after undergoing an additional year of training, said Dr. Joseph Prahlow, president of the National Association of Medical Examiners. (...)

With few forensic pathologists to call on, some coroners have become more selective of what cases merit autopsies, such as performing only external exams on apparent suicides, Prahlow said.

"If you don't have enough people to do autopsies you're going to have to make some decisions to cut down on the number of cases," Prahlow said. In an external exam done by an unqualified pathologist, "the chances that they're going to miss something increases tremendously. (...)

Pathologist apologizes for mistakes investigating child deaths
canada.com 12.11.2007
TORONTO -- Dr. Charles Smith apologized publicly today for mistakes he made in investigating child deaths in Ontario over a decade, as an inquiry began into his disgraced work and broader problems in the autopsy system.

Some of the cases where Dr. Smith made erroneous conclusions led to criminal convictions, some of which have since been overturned.

As three months of hearings on the scandal began, his lawyer, Neils Ortved, addressed the commission and offered an early glimpse of his client's position. (...)

"Dr. Smith sincerely regrets these mistakes and apologizes to all who may have been affected by his errors."

The lawyer added, though, that the former pathologist made the mistakes honestly and with no intention to undermine investigations. (...)

Avslører drap på obduksjonsbordet
helserevyen.no 8.11.2007
(...) Helsepersonelloven etterleves ikke, mener rettsmedisiner.

Det er 43.000 dødsfall i Norge per år. Av disse er 10 prosent «unaturlige» i lovens forstand, skriver Politiforum. Ifølge forskriftene til Helsepersonelloven er følgende dødsfall unaturlige: drap, sjølmord, ulykke, yrkesulykke, feil ved undersøkelse eller behandling av sykdom eller skade, misbruk av narkotika, ukjent årsak når døden har inntrådt plutselig og uventet, dødsfall i fengsel og funn av ukjent lik.

Færre nå enn før
- Skulle denne forskriften til Helsepersonelloven etterleves helt ut, ville det måtte utføres 4300 rettslige obduksjoner i Norge per år, sier rettsmedisiner og professor dr. med. Torleiv Rognum, til politiforum.no. (...)

Ønsker flere obduksjoner
politiforum.no 7.11.2007
Norges fremste rettsmedisiner, Torleiv Rognum, mener det overses to drap per år som et resultat av for lave obduksjonstall.

Ifølge forskriftene til Helsepersonell-loven er følgende dødsfall unaturlige:
• drap
• selvmord
• ulykke
• yrkesulykke
• feil ved undersøkelse eller behand- ling av sykdom eller skade
• misbruk av narkotika
• ukjent årsak når døden har inntrådt plutselig og uventet
• dødsfall i fengsel
• funn av ukjent lik

- Skulle denne forskriften til Helsepersonell-loven etterleves helt ut, ville det måtte utføres 4300 rettslige obduksjoner i Norge per år. Det virkelige tallet i 2005 var 1794. Svenske undersøkelser viser at det per 1000 rettslige obduksjon oppdages ett til to drap som ikke er mistenkt på forhånd. Alle erfarne rettsmedisinere har oppdaget drap på obduksjonsbordet, og de lave obduksjonstallene i Norge innebærer trolig at det overses ca. 2 drap per år, sier professor dr. med, Torleiv Rognum. (...)

Døden som læremester
Torleiv Ole Rognum
Tidsskr Nor Lægeforen 2007; 127: 2785 (1.11.2007)
«Mortui vivos docent» (de døde underviser de levende) står det på veggen i mange obduksjonssaler - men med fallende obduksjonsrate lærer vi mindre og mindre. I Norge obduseres 11 % av de døde. For å ha en valid dødsårsaksstatistikk må man opp mot 30 %. Vår statistikk er derfor ubrukelig som helseindikator. (...)

Færre sykehusobduksjoner - lang svartid
Tidsskr Nor Lægeforen 2007; 127: 2800-2 (1.11.2007)
(...) Resultater. Etter at forskriften ble innført, gikk det årlige antall obduserte ned fra 432 (39 %) til 332 (31 %) av alle døde i sykehuset (p < 0,001). 211 av de pårørende (20 %) ble ikke informert. Antall nektelser økte fra 258 (23 %) til 373 (35 %). Månedlig purring reduserte median svartid fra 58 dager til 38 dager (p < 0,001). Endringen i obduksjonsrutine ga median svartid på 14 dager, mot 46 dager i samme periode året før (p < 0,001).

Fortolkning. Bedre informasjon til pårørende antas å kunne føre til flere obduksjoner. Svartiden for obduksjonsrapporten kan reduseres med enkle tiltak. (...)

Obduksjon - kvalitetssikring i siste ledd
Tidsskr Nor Lægeforen 2007; 127: 2799 (1.11.2007)
Både klinikere og patologer må ha et bevisst forhold til når, hvorfor og hvordan obduksjon i sykehus skal utføres (...)

I 1980-årene ble det utført over 6 000 sykehusobduksjoner per år i Norge. Etter 1990 har det vært under 3 000 per år (1). Den nasjonale obduksjonsfrekvensen ligger nå på rundt 12 %, men det er store regionale forskjeller (1, 2). (...)

Av hensyn til kvalitetskontrollen burde det kanskje utføres obduksjon ved minst en tidel av alle dødsfall - i tillegg til de dødsfall der det er usikkerhet omkring den kliniske diagnosen. Fortsatt er det slik at en del obduksjoner må utføres for å bli «sikker» på dødsårsaken - obduksjonen er rett og slett kvalitetssikring i siste ledd. (...)

De navnløse døde
Tidsskr Nor Lægeforen 2007; 127: 2846-9 (1.11.2007)
Oktober 2006: Hittil i år er det utført 3 340 obduksjoner på Instituto Medico Legal Nina Rodrigues, det rettsmedisinske instituttet i millionbyen Salvador nordøst i Brasil. Flere hundre av de døde gravlegges på den offentlige kirkegården uten at man kjenner deres navn og deres historie. (...)

Fewer Autopsies to Be Performed
yle.fi 22.10.2007
The number of autopsies performed in Finland each year is set to decline, reports Turun Sanomat. Medical examiners opposing the change say fewer autopsies means homicides have a higher chance of going unnoticed. (...)

Currently 11,000 autopsies are performed in Finland each year, which amounts to a quarter of all those deceased. The Ministry of Social Affairs and Health plans to cut down on thousands of autopsies a year to help cut costs. In addition, a great deal of the thirty forensic pathologists currently doing the job will retire in the coming years. (...)

Acquitted Ont. man refuses to blame pathologist
cbc.ca 16.10.2007
'There's enough blame to go around'

William Mullins-Johnson, acquitted Monday of killing his young niece, says he's not harbouring any anger toward the man whose testimony largely led to his wrongful conviction and 12 years behind bars. (...)

Ohio Supreme Court to consider right of coroners to keep organs
ohio.com 5.10.2007
Counties across Ohio may have to change autopsy procedures and face substantial legal costs if the state's high court rules that coroners cannot keep organs for ongoing autopsy testing when the bodies are released to family members. (...)

Autopsy reductions in Austrian capital criticized
pr-inside.com 28.9.2007
VIENNA, Austria (AP) - A decision to reduce the number of autopsies in the Austrian capital is causing debate, with critics saying it could lead to crimes going undetected.

In 2006, Vienna had an autopsy rate of 31 percent, meaning that almost every third body was medically examined. The capital's rate was significantly higher than the countrywide rate one of 21 percent, drawing criticism from the nation's comptroller's office.

In the past, post-mortem exams were performed on everyone who died of natural causes if the exact cause of death could not be determined. (...)

But Thomas Szekeres, vice president of Vienna's Aerztekammer, the professional association of doctors in the capital, said the decrease in autopsies might mean that some murders will go undiscovered.

«Of course it's obvious if there's an ax in someone's neck,» he said. «But it's not always that clear. (...)

«Død mann» våknet
nettavisen.no 17.9.2007
DØD? Carlos Camejo viser frem dokumentene på at han skulle obduseres - etter å ha dødd i en trafikkulykke.

Da legen begynte å skjære i ansiktet hans, våknet Carlos Camejo.
Som tatt ut av en skrekkfilm våknet venezuelanske Carlos Camejo (33) av at kirurgens skalpell skar gjennom ansiktet hans.

- Jeg våknet av at smerten var uutholdelig, sier Camejo til avisen El Universal i Caracas. (...)

Report faults response in Virginia Tech shootings
reuters.com 30.8.2007
(...) Although Cho's motives remained unclear, the report traced his fantasies to the 1999 shootings at Columbine High School in Colorado in which two students killed 13 people.

Cho wrote in a paper in an English class at school some years earlier that he "wanted to repeat Columbine," and later received counseling and medication, the report said. (...)

- Beethoven ble forgiftet av sin egen lege
aftenposten.no 29.8.2007
Hvem drepte egentlig Beethoven? Den østerrikske rettsmedisineren Christian Reiter mener hans egen lege ved en feil forgiftet ham. (Foto: AP PHOTO)
Den store komponisten Ludwig van Beethoven ble forgiftet av sin egen livlege. Men forgiftningen var et rent uhell, hevder den østerrikske rettsmedisineren Christian Reiter. (...)

Akutte forgiftninger i Norge – en epidemiologisk oversikt
farmatid.no (Publisert i NFT nr. 3/2007)
Hvert år dør rundt 500 personer i Norge på grunn av forgiftning. De fleste forgiftningsdødsfall skjer utenfor sykehus og skyldes narkotiske stoffer, først og fremst heroin. Forgiftninger forårsaker ca. 12 000 sykehusinnleggelser per år. Over 60% av disse forgiftningene skyldes legemidler, ca. 25 % skyldes etanol. Bortsett fra høyere dødelighet i Finland, er sykeligheten og dødeligheten av forgiftninger relativt lik i de nordiske landene. Giftinformasjonen får rundt 40 000 henvendelser per år. Paracetamol er det legemidlet som oftest forårsaker potensielt alvorlig legemiddelforgiftning. (...)

REGIONAL: CONFLICTING AUTOPSIES ON STANFORD STUDENT FOUND DEAD IN CAR TRUNK
cbs5.com 20.8.2007
The father of a 23-year-old Stanford University student who was found dead in the trunk of her car in January still insists his daughter was killed and he said last week an autopsy showed she died of blunt force trauma. (...)

Study finds suicide rate may be higher than accepted
independent.ie 20.8.2007 Monday August 20 2007
A new study has reportedly found that Ireland's suicide rate may be significantly higher than previously accepted.

Reports this morning say the study, which is due to be unveiled at a conference next week, concludes that around 600 people take their lives in Ireland every year.

The currently accepted figure is around 500.

The discrepancy arises because deaths classified as "undetermined" during inquests are not included in Ireland's suicide figures. (...)

Coroner's budget shortage pending
post-trib.com 18.8.2007
VALPARAISO -- Porter County Coroner Victoria Deppe hopes her office's credit is good, because she might have to use it. (...)

Task force to study Utah's epidemic of prescription drug deaths
heraldextra.com 1.8.2007
SALT LAKE CITY -- More people died from prescription drug abuse in Utah last year than in traffic accidents, state health department officials said Tuesday.
Of the 476 drug-related deaths investigated by the Office of the Medical Examiner in 2006, nearly two-thirds -- or 307 -- were from an overdose of legal drugs. Of the victims, whose average age was 42, 51 percent were male. (...)

"Prescription drug deaths, all drug deaths, actually are an epidemic in Utah," said Dr. Todd Grey, Utah's chief medical examiner. (...)

Warning of depression drugs risk
stuff.co.nz 8.7.2007
Health professionals have been warned to take greater care advising patients and their families of the risks of taking certain antidepressants found to be a factor in several suicides in Nelson.

Nelson coroner Ian Smith last year began investigating a possible link between SSRIs - selective seratonin reuptake inhibitor medication - and the effects on people suffering mental illness.

Mr Smith issued some of his findings yesterday as part of an inquest into the suicide of David John Stringer, 37, on January 23, 2006.

The coroner said it was not just the prescribing of SSRIs that was a factor in the deaths he investigated, but also the background of the patient's mental health care.

Mr Smith has recommended that New Zealand's warnings be strengthened to the level of those adopted by the United States, which requires a strong black-box warning on prescription information. (...)

Coroner Seeks Stronger Practice For Anti Depressants
newswire.co.nz 6.7.2007
A coroner's inquiry into several suicides in the Nelson region is calling for better care of patients and improved labelling on anti-depressant medication. (...)

Researchers have no brains
news.com.au 2.7.2007
A SHORTAGE of brains for experiments is jeopardising medical advances in psychiatric disorders, neuroscientists have warned.

The Australian Brain Bank Network says falling autopsy rates are directly affecting research into mental illnesses and neurological disorders like Alzheimer's and Parkinson's. (...)

Everything you ever wanted to know about death but were afraid to ask
chronicle-tribune.com 28.6.2007
"How many are CSI fans?" Grant County Coroner Stephen Dorsey asked Wednesday night inside Marion Public Library. (...)

Medical examiner’s office must not face underfunding
enidnews.com 27.6.2007
(...) The National Association of Medical Examiners, which provides accreditation, limits pathologists to no more than 250 autopsies a year. Pathologists in Oklahoma averaged 320 autopsies each last year. The average could increase to more than 400 this year.

Part of the problem is related to salary levels below the industry standard and a nationwide shortage of qualified pathologists.

We cannot allow the office to lose its accreditation. (...)

County death investigations increase in 2006
reviewonline.com 24.6.2007
LISBON — The cost of investigating death in Columbiana County increased last year, with drug deaths partially to blame, according to the coroner’s annual report.

Dr. William Graham and his staff released the figures for 2006 this week, showing an increase in overall cases, autopsies, toxicology tests and drug-related deaths. (...)

Autopsy No drugs, toxic chemicals found in Cho's system
roanoke.com 21.6.2007
A toxicology report shows that Virginia Tech gunman Seung-Hui Cho had no drugs in his system the day of the shootings, state police said today.

"There were no prescription or toxic substances in his system as of April 16, 2007," state police spokeswoman Corinne Geller told The Roanoke Times. (...)

Autopsies in danger of delays, decreases
newsok.com 21.6.2007
If Kevin Rowland is right, the Oklahoma agency responsible for investigating death is barely clinging to life.
In letters sent Tuesday to state funeral directors and district attorneys, Rowland — the chief investigator for the state medical examiner's office — warned that the office is in danger of losing its national accreditation, even as most of the state's forensic pathologists who conduct autopsies and determine cause and manner of death, are poised to retire or resign.

Among the potential consequences, Rowland said, are:

•Lengthy delays in completing death investigations and approving cremation permits, and permits allowing bodies to be taken out of state.
•A vast reduction in the number of autopsies and an attendant increase in the number of deaths ruled "undetermined.” This could mean a steep decrease in benefits paid on accidental death policies.
•Credibility problems when pathologists testify in court because they come from an unaccredited agency.
•Overflowing autopsy suites and bodies stored in refrigerated trucks outside the medical examiner's office.

"This is not some scare tactic,” Rowland said. "This is the reality of what is going on with this office right now.” (...)

Hospitals failing to refer deaths to coroner
smh.com.au 16.6.2007
HOSPITAL doctors are failing to refer almost two-thirds of deaths that should be reported to the coroner, raising the risk that unsafe medical practices or poorly performing doctors might go undetected, Australia's first study of the issue shows.

Complete reporting of deaths that fall under state coroners' acts could be an early-warning system that quickly identifies rogue doctors such as Jayant Patel in Bundaberg, Queensland, or the British serial killer Harold Shipman, said David Ranson, who examined two Victorian hospitals.

He found about a quarter of hospital deaths should have gone to the coroner because they had happened suddenly, unexpectedly or immediately after medical treatment. Only about one in 10 were correctly referred. (...)

Pathologists dead beat - One doctor performs up to 11 autopsies per day!
jamaica-gleaner.com 15.6.2007
(...) "Based on observation we have seen incidents where they have scheduled up to 11 post-mortems per day. Regularly there are about nine post-mortems daily at the facility," said Dr. Gomes. (...)

A former government pathologist, who requested anonymity, said one of the main reasons he left Jamaica was because no one wanted to hear or listen to the truth about the deficiencies of the forensic department.

"For one, the workload is too heavy for the number of pathologists in the department, and that's one of the reasons the autopsies are not properly done," he said. (...)

Autopsy: Inmate died of inflammation
charlotte.com 12.6.2007
An autopsy on a New Jersey man who died in the Catawba County jail last year concluded that his heart muscles were inflamed, causing his death, authorities said Monday.

Harold James Ledet Jr., 28, was found in his cell, unresponsive and not breathing, on Nov. 26, five days after his arrest. He died later that day at Catawba Valley Medical Center.

Sheriff's Office officials announced the findings of the autopsy, conducted at Wake Forest University Baptist Medical Center, on Tuesday, saying it cleared them of any wrongdoing. (...)

Report Drug Deaths On Rise In Florida
local10.com 12.6.2007
New Autopsy Report Lists Cocaine As Primary Culprit
MIAMI -- Illegal and prescription drugs were listed as the official cause of death in thousands of Florida autopsies.

A 2006 drug report that looked at statewide trends said the three most frequently occurring drugs found in Florida autopsies were drinking alcohol, medically termed ethyl alcohol (3,698), cocaine (2,052) and all benzodiazepines (1,987). (...)

Autopsies find 7, 741 with drugs in system
sptimes.com 12.6.2007
(...) The 7, 741 cases in which drugs were found in the systems of people who were autopsied was a slight increase from 2005, when drugs were found in the bodies of 7, 573 people. (...)

The annual Report on Drugs Identified in Deceased Persons is compiled by the Florida Medical Examiners Commission and released by the Florida Department of Law Enforcement.

Most of the 170, 000 or so deaths in Florida in 2006 did not require autopsies, which are ordered when the cause of death needs to be determined or a death is the result of a crime. (...)

Ötzi drept av pil
nrk.no 7.6.2007
Ötzi døde iløpet av få sekunder. Steinalder-mumiens dødsårsak er nå oppklart. (...)

Jamaican autopsies a dead end
jamaica-gleaner.com 1.6.2007
(...) Unanswered questions (...)
Perhaps we will never know the truth. But we are bound to ask, did the autopsy performed on Woolmer meet international standards? We are bound to ask, because Jamaicans For Justice has for a number of years reported on problems with the forensic pathology department of the Ministry of National Security. (...)

Autopsies reviewed after forensic doubts
news.com.au 5.6.2007
HUNDREDS of suspicious deaths may be reviewed after a damning report into the NSW's CSI laboratory - the NSW Institute of Forensic Medicine.

The possibility of a mass review by health authorities follows a finding that senior forensic pathologist Dr Allan Cala was guilty of unsatisfactory professional conduct after he wrongly ruled a double murder was an accident. (...)

Some Slayings in Navajo Nation May Be Missed for Lack of Autopsy
washingtonpost.com 2.6.2007
Owed $254,000, New Mexico Refuses to Perform Them (...)

Body count
theaustralian.news.com 2.6.2007
• Sometimes the factors that ended someone's life only become apparent in death. But as Sean Parnell reports, a decline in autopsies is allowing some secrets to go to the grave (...)

THE public fascination with autopsies may have started with American TV coroner Quincy MD, but post-mortems are now commonplace on the small screen. On crime and hospital dramas such as CSI and House, unravelling the mysteries of death has become a scriptwriter's favourite pastime. (...)

Probe finds 91 incomplete, paid Bossier autopsies
shreveporttimes.com 31.5.2007
The death of longtime Caddo Coroner George McCormick in 2005 immediately raised questions, red flags and concerns about uncommon practices in his office.

Rumors surfaced about forged death certificates, fake documents and financial improprieties at the Caddo coroner's office and a Bossier Parish forensics laboratory that prompted an investigation by the Bossier district attorney. (...)

'Virtual autopsy' helps identify drowning as cause of death
eurekalert.org 29.5.2007
OAK BROOK, Ill. -- "Virtual autopsy" performed with multidetector computed tomography (MDCT) can aid forensics teams in determining if a person has drowned, according to a study published in the June issue of Radiology.

MDCT is comparable to conventional autopsy in demonstrating airway froth and sediment that are indicative of drowning. (...)

Echorouk visits autopsy room and discovers psychic sufferance there
echoroukonline.com 26.5.2007
A reporter from Echorouk has gone to autopsy department in Bachir Ben Nacer hospital in Biskra (southern Algeria) where he met Mohamed Kahmam who has worked as an assistant of the forensic scientist Farid Boukhenouche for 10 years. The reporter entered into the autopsy room to see how the medical procedure is performed. (...)

Autopsy rates down since 2002
sunpost.net 26.5.2007
The San Joaquin County Coroner’s office has done fewer autopsies each year for the past several years, according to its annual report, released this month. (...)

When a coroner can determine the cause of death using reports from other doctors and investigators at the scene of a crime, there is no need for a full autopsy. (...)

Performing fewer autopsies also saves money, Angeli said. The standards used to decide if a full investigation is necessary haven’t changed, she added.

A man is twice as likely to be the subject of a coroner’s investigation as a woman, the report also says. It lists 462 checks of male deaths in 2006, against only 216 investigations for female deaths. (...)

Morenci students experience autopsy via video
lenconnect.com 23.5.2007
Columbus, Ohio. — Telegram photo by Mike Calamungi
The interactive video explained the various stages of an autopsy to Morenci High School students and others around the country. (...)

“In Depth: Autopsy,” as the program is called, is not for the faint of heart. Students were exposed to all imagery associated with an autopsy including the cutting of skin, bones and organs. The program kept a lighthearted nature, though, as many of the procedures were compared to everyday activities. Some of the terms used included “bread loafing,” which refers to a method of dissecting organs, and the Rokitansky method of removing organs from the body, which was compared to holding a Christmas turkey. (...)

Sloppy forensic system questioned / Autopsy rate for unnatural deaths lower than 10%; new doctors shunning field
yomiuri.co.jp 21.5.2007
Forensic doctors ridicule certain facets of this country's medical practices, saying, "The living are offered advanced care, but the dead receive Edo-period treatment," meaning that while sick people receive excellent medical treatment, those who die of unnatural causes are cursorily examined only by sight or touch--a practice not much different from that used during the Edo period (1603-1867).

With a shortage of forensic doctors, equipment and funds, the autopsy rate for unnatural deaths is lower than 10 percent--a figure that continues to fall.

Such a low rate is not likely to benefit public hygiene, nor is it likely to prevent crime and accidents. (...)

Garage deaths caused by carbon monoxide, autopsy reveals
dailysouthtown.com 20.5.2007
Four young people whose bodies were found Friday inside a Southeast Side garage died accidentally of carbon monoxide poisoning, autopsies confirmed Saturday. (...)

Coroner considers alert over drugs
oxfordmail.net 16.5.2007
A coroner is considering calling for an investigation into the side- effects of two drugs following an unexplained death.

Oxfordshire coroner Nicholas Gardiner recorded an open verdict on Janet Green, 50, of Kate Turnbull House, in Sandford Road, Littlemore, Oxford, at an inquest.

He is now considering calling on the Government's medicines regulatory agency to look into her death. Mrs Green, who was born with cerebral palsy and had schizophrenia and depression, was found with five times the level of anti-depressant fluoxetine in her blood than that normally expected in someone using the drug.

The level of anti-schizophrenia drug sulpiride was also nearly high enough to cause death on its own, the inquest heard.

Mr Gardiner said he would consider issuing a 'yellow card report' on the drugs. (...)

Autopsy rate lowest in developed world
yomiuri.co.jp 17.5.2007
Only about 9 percent of bodies of people who died of unnatural causes unknown reasons handled by the nation's police in 2005 underwent autopsies, with the remaining 134,905 bodies only examined by sight and noninvasive means, it was learned Wednesday. (...)

Book Review: Cause of Death: Forensic Files of a Medical Examiner
monstersandcritics.com 14.5.2007
Non-Fiction Book Reviews (...)

Medical profession should address issue
republicanherald.com 9.5.2007
To the Editor:
In his letter lamenting the decrease in autopsies, Dr. DiNicola eloquently recalls observing medical autopsies at Thomas Jefferson Medical College in Philadelphia. Curiously, he fails to tell us that these expensive procedures were not performed by the Philadelphia Medical Examiner at taxpayer expense.

Instead, they were conducted by Jefferson medical staff, and funded with the tuition he paid. (...)

More Than 10% of U.S. Adults Develop Drug Problems
healthfinder.gov 7.5.2007
Many of these abuses are associated with psychiatric disorders, study finds. (...)

Prescription drug abuse up sharply in the USA
The Lancet 2007; 369:1505-1506
Government officials are warning that the abuse of pharmaceutical drugs is becoming a major public-health problem. Although abuse of prescription drugs has been increasing in the USA for several years, the latest statistics show a recent sharp rise. Michael McCarthy reports.

Abuse of pharmaceutical drugs is increasing in the USA, according to the latest government statistics, which show that visits to US emergency departments related to non-medical use of pharmaceuticals, including prescription drugs and over-the-counter products, jumped 21% from 2004 to 2005. (...)

Audit: Autopsy rate misses state standards
orlandosentinel.com 5.5.2007
(...) Autopsies, some initiated as long ago as 2005, are yet unfinished. (...)

Nelson said death-ruling delays frustrate survivors, impede police investigations, hold up payments of insurance benefits and slow probate proceedings.

State guidelines suggest that 95 percent of autopsy reports in cases of homicide should be completed within 60 days and by 90 days for all other cases.

The audit showed autopsies have often been delinquent in District 5 -- 26 percent were tardy in 2004, a rate that rose to 33 percent in 2005 and 48 percent in 2006. About 2,400 autopsies were performed in those years. (...)

Cogswell left behind about 70 unfinished autopsies when he resigned. Nelson said Cogswell has since completed about half. (...)

A balance of career, fitness - on the run
denverpost.com 30.4.2007
Jefferson County Deputy District Attorney Bob Weiner says he finds himself "being able to resolve issues" regarding work when he goes for a run. (Post / RJ Sangosti)

Jefferson County Deputy District Attorney Bob Weiner has a passion for his job, but that doesn't mean it's easy. Imagine the stress of trying to help rape victims or families of homicides, knowing there's a limit to the comfort you can bring them.

You can't undo what happened to shatter their lives. You can only hope to bring some justice and closure. (...)

Forensic Pathologists Tell Physiologists What They Know About Death And What Puzzles Them
medicalnewstoday.com 1.5.2007
When four forensic pathologists tell physiologists about the deaths that puzzle them, they will do so with the hope of sparking laboratory research to help define the cause of these deaths and prevent more of them.

The four pathologists, all medical examiners and professors, will present their insights, as well as uncertainties, about deaths that happen as struggling individuals are arrested, as infants sleep in their cribs, and following years of drug abuse. By sharing these experiences with physiologists, the medical examiners hope to spur research to clarify how these deaths occur, how to identify them during autopsy, and how to prevent them. (...)

Criminal defence lawyers must share blame, expert says
theglobeandmail.com 30.4.2007
JUSTICE REPORTER — The criminal defence bar must share the blame for a growing scandal involving botched autopsies of dead children, says a member of an expert panel that discovered apparent mistakes in 20 cases conducted by pathologist Charles Smith. (...)

Full public inquiry called into pathologist's work
cbc.ca 23.4.2007
The Ontario government has called a full public inquiry into the work of pathologist Dr. Charles Smith, whose work is under question in more than a dozen cases, CBC News has confirmed.

A coroner's review of Smith's work in Ontario dating back to 1991 raised concerns about his conclusions in 20 of 45 child autopsies.

Of the flagged cases, 13 had resulted in criminal convictions, with one person still behind bars. (...)

Cho's Autopsy Has No Hint of Psychological Problems
allheadlinenews.com 23.4.2007
Blacksburg, VA (AHN) - Dr. William Massello, the assistant state medical examiner for Virginia has said that Virginia Tech student and gunman Seung-Hui Cho died from a self-inflicted gunshot wound to his temple but there was nothing found in the autopsy that would have hinted at psychological problems.

"There was nothing unusual about Cho's autopsy,' the Roanoke-based Dr. Massello said Sunday. (...)

Cho's blood samples were sent for toxicology testing to find out if Cho was on drugs during the shootout, but Massello said it could take as long as two weeks to get results. (...)

Errors made in 20 child autopsies
fftimes.com 20.4.2007
TORONTO —William Mullins-Johnson is a step closer to getting his life back now that Ontario’s chief coroner has concluded he and 12 others who were convicted in a variety of child deaths may have been sent to jail because of bad forensic evidence.

“Something was made out of nothing and my life was taken from me,” the man from Sault Ste. Marie, Ont. said nervously at a news conference yesterday.

Moments earlier, chief coroner Dr. Barry McLellan had made a long-awaited announcement that a team of forensic experts found errors were made in 20 of 45 child autopsies conducted by former Toronto pathologist Dr. Charles Smith since 1991.

Twelve of those cases resulted in criminal convictions and one ended with a finding of not criminally responsible. A number of other people were wrongly accused and served jail time before charges were dropped. (...)

Stråle-testet stjålne kroppsdeler
nrk.no 18.4.2007
Atomanlegget i Sellafield skal ha fjernet kroppsdeler fra døde arbeidere for å teste dem for stråling. Nå skal regjeringen granske påstandene.

Fagforeninger for ansatte i kjernekraftindustrien sier vev, kroppsdeler eller organer er fjernet fra opp til 70 personer som arbeidet ved Sellafieldanlegget, uten at pårørende er spurt eller har gitt samtykke. (...)

FAMOUS ENDINGS
miamiherald.com 9.4.2007
Some other celebrities had prescription-related deaths: (...)

A fascination with death
sun-herald.com 9.4.2007
Dr. Riazul Imami has been Charlotte County's medical examiner since 1976, and he has yet to tire of it

Dr. Riazul Imami met his patient when he was pulled out of a body bag. (...)

The grotesque scene of the autopsy room seemed a completely natural environment for Imami. Using a sharpened pencil as a pointer, he showed Theresia Elrod, a professor of anatomy and physiology at Manatee Community College, the chambers of the dead man's heart and the the contents of his stomach. (...)

Skjerper regler for organhøsting
dagbladet.no 7.4.2007
Fra og med 1. mai innfører Kina strengere regler for den kommersielle handelen med organhøsting. Det har vist seg at forbudet mot ulovlig organhøsting fra henrettede fanger som ble innført 1. juli 2006 er vanskelig å håndheve.

Det blir nå færre sykehus som får lov til å utføre organtransplantasjoner, og det vil bli straffbart å høste organer uten donors godkjennelse, skriver BBC. (...)

Unfinished autopsies cause problems in court
al.com 4.4.2007
TUSCALOOSA - Dr. Johnny Glenn, the lone forensic pathologist performing autopsies in the poorest part of Alabama, was slipping.

In hundreds of cases, he would examine bodies but put aside his notes, never finishing the reports or filling in diagrams that are crucial to death investigations.

But because Glenn worked with virtually no supervision, the extent of the backlog - and exactly what he was going through personally - would not become clear until after he abruptly resigned in 2004. (...)

'Jamaica needs more forensic pathologists'
jamaica-gleaner.com 28.3.2007
Dr. Garfield Blake, immediate past president of the Jamaica Association of Clinical Pathologists, has renewed calls for the Government to increase the number of forensic pathologists.

The role of the forensic pathologist is to determine the cause and manner of death in incidents such as homicides, accidents, suicides, suspicious deaths, sudden and unexpected deaths, among others. (...)

Fewer Autopsies Performed than a Decade Ago
cdc.gov (March 2007)
In 2003, autopsies were reported as performed on 173,745 decedents, or 7.7 percent of the deaths. (...)

Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991-2003
Centers for Disease Control and Prevention (CDC)
MMWR Morb Mortal Wkly Rep. 2005 Jan 21;54(2):33-6
Deaths caused by drug poisoning of unintentional and undetermined intent are an increasing problem in Utah and elsewhere in the United States. To characterize the trend in drug-poisoning deaths in Utah, CDC and the Utah Department of Health analyzed medical examiner (ME) data for 1991-1998 and 1999-2003. This report summarizes the results of that analysis, which determined that, during 1991-2003, the number of Utah residents dying from all drug poisoning increased nearly fivefold, from 79 deaths in 1991 (rate: 4.4 per 100,000 population) to 391 deaths in 2003 (rate: 16.6). (...)

Quick burial blocks autopsy
bangkokpost.com 26.3.2007
A combined police-medical team was yesterday prevented from performing a mandatory autopsy on a senior Muslim preacher who was murdered in Yarang district of Pattani on Saturday. When the team arrived they learned relatives of Arsae Hayi Salae, 44, had already buried him. (...)

Ore. assisted-suicide data challenged
sbcbaptistpress.org 19.3.2007
WASHINGTON (BP)--More people than ever before died in Oregon last year by physician-assisted suicide, but a bioethics specialist questioned if the state’s recent report provides a full accounting in the only state to legalize the practice.

The Oregon Department of Human Services reported 46 people took their lives in 2006 using lethal doses of drugs prescribed by doctors. That was an increase of eight over 2005. Previously, the largest number of assisted suicides reported in a year was 42 in 2003.

Wesley Smith, who writes online at www.bioethics.com, described the report as “virtually meaningless,” however, saying “its statistical analysis depends almost entirely on death doctor self-reporting.”

“(T)here is no independent oversight by the state over assisted suicide, (and) the DHS does not even have the power or budget to investigate potential abuses,” Smith wrote. (...)

Anna Nicole Smith autopsy inconclusive
inthenews.co.uk 16.3.2007
Police investigating the death of model Anna Nicole Smith have announced that initial autopsy results are inconclusive and no illegal drugs were found in her hotel room.

Former playmate Ms Smith died in her Floridian hotel room last month aged 39. The blonde bombshell, born Vickie Lynn Hogan, was once called the "next Marilyn Monroe" for her voluptuous figure and styling herself on the troubled actress for the cover of Playboy magazine.

"We found no illegal drugs, only prescription medicines," Seminole police officer Charlie Tiger told the press. (...)

Autopsy of 25-year-old shows lethal mix of drugs
newsargus.com 13.3.2007
Blood samples taken from a young woman who was found dead at Econo Lodge on New Year's Day showed she had a lethal mix of methadone and cocaine in her body when she died, a state autopsy report shows. (...)

Pathologist uses science to determine diseases, death
fremontneb.com 10.3.2007
When people think of coroners and pathologists, many think of popular television shows.

“It's not like CSI. CSI is so far from reality,” said Dr. Rod Koerber, medical director of pathology at Fremont Area Medical Center. “We can't solve crimes with just trace bits of evidence.” (...)

The closest he said he's come to a “CSI” case was when he performed an autopsy on a person believed to have overdosed on drugs and through testing found out the person actually committed suicide by drinking anti-freeze. (...)

Stort behov for forskning på effektive selvmordsforebyggende tiltak
fhi.no 7.2.2007
Det finnes lite vitenskaplig dokumentasjon på hva som faktisk forebygger selvmord hos pasienter i psykisk helsevern. Det viser en kunnskapsgjennomgang utført av Kunnskapssenteret. Rapporten viser at tiltak for å sikre kontinuitet i behandling av selvmordsforsøkere, som for eksempel brev og telefonkontakt, tverrfaglige team og ulike beskyttende tiltak, er lite dokumentert. (...)

Alvorlig folkehelseproblem
Norge hadde lav selvmordsrate sammenliknet med andre land fram til 1970-tallet. Etter dette kom det en økning, før tallet på selvmord igjen sank fra starten av 1990-årene. Det blir nå registrert om lag 525 selvmord per år i Norge, men det er grunn til å tro at det offisielle tallet er 10-25 % for lavt, blant annet på grunn av mangler ved registreringssystemet. (...)

Autopsy results shocking: pathologist
stuff.co.nz 22.2.2007
A Hamilton pathologist says there would be some shocking results if more autopsies were performed.

Medlab pathologist Richard Doehring made the claim after a Christchurch coroner found that the death of Green Party co-leader Rod Donald was due to a rare complication caused by campylobacter. (...)

Bodies disgrace: GP shortage blamed
smh.com.au 20.2.2007
BODIES are being transported across the state in unrefrigerated vans because the Department of Health cannot supply rural centres with enough doctors trained to perform autopsies. (...)

Fatal Levels of Sedative Found in Zhou's Autopsy
tech.mit.edu 20.2.2007
(...) Zhou's toxicology tests detected diphenhydramine at 6.15 mg/L, exceeding the "toxic range" of 1–5 mg/L, according to a Sonoma County Coroner's Office press release. Diphenhydramine is an ingredient in over-the-counter drugs such as Benadryl and sleep aids.

"No other common acidic, neutral or basic drugs [were] detected," the press release stated. "No blood or urine ethyl alcohol [was] detected." (...)

Autopsy reveals legal drug
mercurynews.com 16.2.2007
BENEDRYL-LIKE MEDICINE IN STANFORD STUDENT'S BODY
Stanford University doctoral student Mengyao "May'' Zhou -- found dead in Santa Rosa days after she vanished from the campus -- had a high level of a legal drug in her system, the Sonoma County coroner's office reported Thursday night.

Although coroner's officials said a cause of death has yet to be determined, they did find a toxic level of diphenhydramine, the antihistamine and sedative found in the allergy medication Benadryl and other drugs. Tests found 6.15 milligrams per liter in Zhou's system; 1 to 5 milligrams per liter is the potentially toxic range. (...)

RMV vill ha virtuella obduktioner
dagensmedicin.se 15.2.2007
Rättsmedicinal-verket vill att virtuella obduktioner genom datortomografi ska införas över hela landet. I Linköping har tekniken använts med stor framgång i flera år.

Det är på centrum för medicinsk bildvetenskap och visualisering, CMIV, i Linköping som metoden med virtuella obduktioner har praktiserats sedan 2003.
Cirka 160 datortomografiundersökningar av avlidna har genomförts, och det är i dag rutin att alla kroppar undersöks virtuellt om det finns misstanke att dödsfallet orsakats av en annan person, skriver Landstinget i Östergötland i ett pressmeddelande. (...)

Coroner to probe drug-death link
stuff.co.nz 13.2.2007
The Nelson coroner is investigating the relationship between a certain type of anti-depressant drug and suicide. (...)

ANNA NICOLE'S BEST FRIEND: `IT WASN'T SUICIDE'
contactmusic.com 14.2.2007
ANNA NICOLE SMITH's best pal has scoffed at reports the model took her own life - because she had too much to live for. Professional volleyball player JACKIE HATTEN was stunned by her pal's death last week (08FEB07) but insists there's no way Smith committed suicide. (...)

Coroner Worried About Anti-Depressant Use And Suicide
newswire.co.nz 14.2.2007
The coroner in Nelson is concerned there is a link between suicides and the use of a type of anti-depressant drug.

The comments follow his investigation into the death of a 21 year old man from Nelson last July, who was prescribed two types of selective serotonin re-uptake inhibitors, known as SSRIs.

The coroner, Ian Smith, says SSRIs have been linked to an increase in suicidal tendencies, because people become more focused when they use them.

He says anyone who is prescribed an SSRI should be told how the drug will make them feel and then monitored closely, especially during the first month of use. (...)

Metanolrykter
nrk.no 13.2.2007
- Det er umulig å fastslå i den foreløpige obduksjonsrapporten om 30-åringen som døde i fyllearresten i Narvik, døde som følge av metanolforgiftning.

Det bekrefter rettmedisinere som NRK har snakket med.
Ifølge Harstad Tidende pågår det nå en SMS-aksjon som advarer mot hjemmebrent med metanol.

I tekstmeldingen blir dette knyttet opp mot dødsfallet i Narvik natt til søndag.
Den endelige obduksjonsrapporten er ventet først om to måneder. (...)

- Jeg orker ikke å fortsette
side2.no 12.2.2007
En nær venninne av Anna Nicole Smith sier at modellen ønsket å dø. (...)

Ifølge venninnen gikk Anna Nicole på antidepressive medisiner som Xanax og Prozac, samt slankepiller og smertestillende. (...)

- Jeg vet ikke om hun tok selvmord, men jeg vet at hun ønsket å dø. Jeg tror kanskje at kroppen hennes bare ga opp, forteller venninnen. (...)

Murder not only reason for autopsy
fortwayne.com 11.2.2007
Pathologists examine unexplained deaths, small-child fatalities (...)

Those include the many deaths when seemingly healthy people drop over, said Dr. Michael O’Connell, the St. Joseph County coroner.

“If the death can’t be explained or the person didn’t have a physician, we have to come up with a cause of death and sign the certificate,” said O’Connell, a longtime family doctor in South Bend. The coroner also determines the manner of death, with the death certificate allowing for one of five possibilities: homicide, suicide, accident, natural or undetermined. (...)

In 2005, his office took jurisdiction over 238 deaths, about 10 percent of the county’s total number of deaths.

Of the 115 autopsies done for coroner’s cases, nearly six times as many were for unexpected natural deaths as for homicides, (61 vs. 11).

The rest were divided among accidents (31) and suicides (7). In five cases, no cause could be found. (...)

Reasons for increase in teen suicides debated
citizen-times.com 11.2.2007
(...) Trend not easy to quantify
R. Trent Codd, a licensed psychologist practicing cognitive behavioral therapy in Asheville, isn’t as quick to attribute the spike to the warnings.

“It would take several years of data to properly detect a trend,” he said. “This is just one year and I believe it’s too early to attribute it to anything. … One would have to rule out tons of confounding variables to establish causality such as: divorce rates, geographical variations, rates of child abuse, violent crime, etc.” (...)

Editorial: Worcester's Early already running late
metrowestdailynews.com 10.2.2007
The body of Anna Nicole Smith was found Thursday afternoon in her hotel room. Within 24 hours an autopsy had been completed.

The body of a newborn baby was found in a garbage truck in Milford Jan. 6. More than a month later, no autopsy results have been released to police or the public, and no charges have been lodged against the mother or anyone else. What's going on here? (...)

Anna Nicole Smith Autopsy Results
wlns.com (10.2.2007)
New developments in the mysterious death of celebrity Anna Nicole Smith. The autopsy to determine just how she died is now complete, and the doctor released preliminary results. (...)

More tests are needed to determine what caused Anna Nicole Smith's death. Calling it a "medical puzzle," the medical examiner says it could be three to five weeks before there is a final determination. The first official word on what killed Anna Nicole Smith the medical examiner says the results of a six hour autopsy are inconclusive.

Dr. Joshua Perper, Broward County Chief Medical Examiner: "When somebody takes a large amount of pills, usually find pills in the stomach, did not find any pills in the stomach." (...)

Autopsy: Baby died after mother's drug use
myrtlebeachonline.com 9.2.2007
Autopsy results released Thursday on a stillborn child show the infant died after her mother took cocaine, authorities said. (...)

The Law Explored: the coroner
timesonline.co.uk 8.2.2007
(...) Having a reliable system for charting who is dying, and in what circumstances, is of considerable social value. It is important for us to know, for example, that there were 3,200 suicides in England and Wales in 2005, as this should inform public policy related to the health service, community services, custodial policy and the emergency services. (...)

In the English legal system, the coroner's court is unique in using an inquisitorial process. There are no "sides" in an inquest. There may be representation for people like the relatives of the deceased, insurance companies, prison officers, car drivers, companies (whose policies are possibly implicated in the death), and train drivers, to name a few, but all the witnesses are the coroner's witnesses. (...)

Medical examiner proposal withdrawn
February 8, 2007
indystar.com 8.2.2007
Sponsor amends bill seeking a statewide system with regional offices to aid coroners (...)

Revisions to bill
Rep. David Orentlicher removed all references to a state medical examiner system from HB 1503. Among the revised bill's provisions:

• Autopsies: Required for deaths of children who are 1 week to 3 years old and would be performed by a certified child pathologist. Coroners would consult with the pathologists on whether to order autopsies for older children.
• Reporting: Coroners would have to notify local and state child fatality review teams of each death of a child under 18.
• Child review teams: Local and state committees could subpoena records from health-care providers.

Remaining provisions would require autopsies of young children to be done by certified child pathologists and would require coroners to report all deaths of children under 18 to local and state child fatality review teams.

Dr. Antoinette Laskey, leader of the Indiana State Child Fatality Review Team, told the committee that legal hurdles have hindered its work by limiting its access to information. (...)

Molecular autopsy detects genetic defects
upi.com 2.2.2007
-- Postmortem genetic testing -- molecular autopsy -- has been found to detect genetic defects that impair the heart's rhythm center, say U.S. researchers.

Conventional autopsies found no cause of death for 49 young people who died suddenly and inexplicably at an average age of 14, but using molecular autopsy Mayo Clinic researchers found that more than one-third died due to potentially heritable genetic defects. (...)

Mayo Clinic Research Shows 35 Percent of 49 Young People Who Died Suddenly and Inexplicably Had Genetic Heart Defects
earthtimes.org 30.1.2007
-- In 49 young people who died suddenly and inexplicably at an average age of 14, conventional autopsies found no cause of death. But when Mayo Clinic researchers conducted a sophisticated form of postmortem genetic testing -- known as a molecular autopsy -- they found that more than one-third died due to potentially heritable genetic defects that impair the heart's rhythm center. (...)

Less time for the crime
napavalleyregister.com 6.1.2007
(...) "(Melinek) said some procedures that should have been done at the autopsy were not. Her review of the autopsy and medical records showed Ronnie had substantial head injuries prior to him coming to live with Eddie and Linda. His injuries had been a concern of Child Protective Services for years," Lernhart said. (...)

Medical examiner system finally coming to county
recordonline.com 4.1.2007
Goshen — After decades of discussion and debate, Orange County lawmakers this afternoon finally created a medical examiner's office, propelling the county into the modern age and embracing a change that law enforcement, health officials and funeral directors have advocated for years. (...)

Information about suicide
chron.com 16.12.2006
(...) Most people thinking about suicide want very much to talk about how they are feeling and are relieved when someone else recognizes their pain. Avoiding the subject can be deadly. (...)

_Few attempted or completed suicides happen without some warning. Friends and relatives of people who commit suicide often say the intention was hidden from them, but it's more likely they just didn't recognize it. (...)

Rs 5, for cleaning mess after autopsy
cities.expressindia.com 16.12.2006
Cleaning up after a post-mortem is an unenviable task. But what makes it doubly unappealing is the fact that one gets paid no more than Rs 10. (...)

Evidence of autopsy done in 1600s discovered
ama-assn.org 18.12.2006
Today's scientists used modern technology to determine the French colonist died from scurvy and exposure. (...)

Scientists Confirm St. Croix Autopsy Occurred In Early 1600s
allheadlinenews.com 1.11.2006
- A team of forensic anthropologists have concluded that the skull of a man buried on St. Croix Island during the winter of 1604-05 had been autopsied. It is the earliest confirmed autopsy in North America. (...)

Doctor of Anna Nicole Smith's Son Blamed
toronto.fashion-monitor.com 29.9.2006
Pathologist has blasted the doctor who prescribed the antidepressants and painkillers for Daniel Smith.

Pathologist Cyril Wecht, who had recently discovered the lethal drug combo that killed Anna Nicole Smith's son, has blamed the doctor who prescribed the anti-depressants and painkillers for the death of Daniel Smith, 20.

Daniel Smith died due to the intake of methadone, Zoloft and Lexapro, which combined to cause a lethal cardiac failure, the famous pathologist has concluded. (...)

Most hospitals avoid autopsies in SIDS cases
japantimes.co.jp 24.10.2006
The health ministry said Monday that 74 percent of hospitals have ignored a requirement to perform autopsies on babies when concluding their deaths were caused by sudden infant death syndrome. (...)

Flere dør i farlige sexleker
dagbladet.no 22.9.2006
Stadig flere dør som følge av kvelning under seksuell aktivitet som kommer ut av kontroll. Gutter og unge menn er mest utsatt, ifølge politiet (...)

Second autopsies possible
kentucky.com 17.9.2006
RESULTS SHOWING PAIN, SUFFERING COULD FIGURE IN DAMAGE CLAIMS (...)

Billings man found dead below Rims
billingsgazette.net 4.9.2006
Police on Monday recovered the body of a 52-year-old Billings man at the base of the Rimrocks on the West End.

The body of Steven Fraker was found below a sheer limestone cliff about 70 feet from a walking trail above Laredo Place, just west of Westfield Drive.

The body was located another 100 feet from where the jagged hills reach Laredo Place.

“We’re speculating it was suicide, but we won’t know for sure until the autopsy,” Deputy Coroner Keith Montgomery said. (...)

Autopsies are life for county's `Dr. Death'
sun-sentinel.com 4.9.2006
(...) Homicides are up. In the first six months there were 59, up 11 from last year. Criminal-justice advocates said the county is on its way to a record year for killings. Bell said it comes in spurts. And it never surprises him.

"People get really angry at one another," said Bell, the former deputy chief medical examiner for Broward County. "As soon as you see one case that looks brutal ... there might be a case in the future that's worse."

Even with the spike in homicides, Bell said, three main causes of death in Palm Beach County are heart disease, traffic accidents and drug overdoses.

There's nothing tender about an autopsy. The bodies come in all shapes and sizes. Some come bloated and discolored, barely resembling a human being, from being dead for days or months, sometimes under water. (...)

How did he die?
suburbanchicagonews.com 23.8.2006
Susan Grant tried to organize her thoughts. She was nervous but confident these strangers would believe her.

Sue Grant stands in her garage where her husband died: 'Just because he was an alcoholic and depressed doesn't mean he committed suicide.' (...)

Long term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway
Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G.
Diabetologia. 2006 Feb;49(2):298-305. Epub 2005 Dec 20
Department of Pediatrics, Ullevål University Hospital, N-0407 Oslo, Norway. torild.skrivarhaug@medisin.uio.no

AIMS/HYPOTHESIS: We examined long-term total and cause-specific mortality in a nationwide, population-based Norwegian cohort of patients with childhood-onset type 1 diabetes. MATERIALS AND METHODS: All Norwegian type 1 diabetic patients who were diagnosed between 1973 and 1982 and were under 15 years of age at diagnosis were included (n=1,906). Mortality was recorded from diabetes onset until 31 December 2002 and represented 46,147 person-years. The greatest age attained among deceased subjects was 40 years and the maximum diabetes duration was 30 years. Cause of death was ascertained by reviews of death certificates, autopsy protocols and medical records. (...)

One death initially classified as intoxication was reclassified to hypoglycaemia, three cases from epilepsy to sudden death, and seven cases from
accident to suicide. (...)

The clinical review committee reclassified seven causes of death from accidents to suicides. There is reason to believe that this under-reporting of suicide is similar both for the patient cohort and for the background population. The mortality from suicide was not significantly greater in patients with diabetes compared with the general population. However, the clinical review committee indicated that suicide had been under-reported and found 13% of the total
deaths to be suicides. This high number of suicides may indicate increased psychiatric vulnerability and burden associated with childhood-onset type 1 diabetes. (...)

Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data
BMJ 2002;325:1332-1333 (7 December)
Several studies over the past 15 years have compared the number of fatal poisonings due to antidepressant drugs in the United Kingdom with drug use statistics to derive a fatal toxicity index: deaths per million prescriptions.^{1 2}