Autopsy brain manual and next step

31 Jan

            I posted the autopsy manual on the brain today with the same complaints, e.g. that half the images I had in my database were never digitized. I did not even have on photo of holoprosencephaly or of CMV in the brain. Still, I think the autopsy manual sections that I have posted so far will allow me to justify the details of the autopsy protocol for the stillbirth study.

            I want for the study to be able to attempt to correlate physiologic changes of different duration and form, from different stresses on the fetus, with the clinical features and the placental findings. 

            Using the autopsy as a tool to understand lethal physiology is difficult because of differences in gestational age, length of intrauterine postmortem retention, and complex overlapping physiological change. The goal at this point is to develop reasonable techniques and ideas for testable hypotheses. The main difference between the usual autopsy and the study protocol will be the attempt to find reliable methods of quantitation from the gross and microscopic observations. 

For example:

            Does the duration of gasping change the lung volume, the amount of blood in the lung capillaries and the distribution of intrathoracic petechiae?

            Does a severe acute but then resuscitated asphyxial episode lead to detectable changes in the brain with neuronal necrosis or white matter gliosis, or with brain edema as measured by weight compared to gestation?

            Does subacute hypoxia lead to heart failure measured by the volume of effusions, the dilatation of the ventricles, or the loss of atrial or brain natriuretic peptide. 

            What features clinical and placental features lead to lipid accumulation in the adrenal and loss of thymic cortical lymphocytes?

            What events correlate with increased nucleated red cells in the circulation, with or without, an increase in erythropoiesis measured by volume % or synchrony in the liver?

            Was blood acutely shunted away from the kidneys, or other non-vital organs?

            Are changes in the ductal intima indicative of contraction and right ventricular strain and passive congestion in the liver or other organs.?

            Does mobilization of colloid in the thyroid, normally triggered by birth, occur in utero and under what conditions?

            Does insulin or somatostatin islet cell hypertrophy or hyperplasia occur in physiologic states other than maternal diabetes?

So before going to some other organ manuals like bone, skin and pituitary, I am going to start on the detailed autopsy protocol.

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