CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Read an excerpt from the chapter in Autopsy Performance & Reporting titled “Pregnancy-Related Death and the Autopsy Examination” is written by Cynthia Schandl, MD, PhD, of Medical University of South Carolina.
Autopsy Performance & Reporting is a new book from CAP Press, released in April. The editor, Kim A. Collins, MD, and her 43 contributors wrote 40 chapters on facility design, safety, high-risk cases, the oral cavity, the placenta, the pediatric autopsy, special studies of the heart and lungs, postmortem microbiologic testing, photomicrography, and much more. “I know of no other autopsy book like this on the market,” Dr. Collins tells CAP TODAY.
Beginning on page 75 is an excerpt on the hepatic system from the chapter on “Pregnancy-Related Death and the Autopsy Examination,” by Cynthia A. Schandl, MD, PhD, associate professor, Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston.
Dr. Collins is a forensic and autopsy pathologist, Newberry Pathology Associates, Newberry, SC. CAP TODAY asked her recently about the new book. Here is what she told us.
The second edition of this book was published in 2003. Why is now the time to publish the new edition?
Fourteen years have passed since the second edition. Many developments have been made in virtually all areas of medicine, including all branches of pathology. The autopsy pathologist incorporates this new knowledge and the advancements, applies them to the autopsy, and enhances its value. Now it’s time for autopsy pathologists to have a current and complete text to reference to enhance their practice of medicine and their service to their patients. Although the autopsy procedure has great historical roots, the application and use of the autopsy have changed greatly to this day.
Can you tell us about some of the new and updated material in it?
I can honestly say all of the material is updated. Even the amazing history chapter has images and a timeline and teaches many facts that have never been presented in an autopsy text. For instance, as we have learned more about maternal deaths and degenerative brain disease, we have updated all of that new information based on current research. Current laboratory accreditation is advancing to ISO accreditation, and that important information is also updated in the laboratory accreditation chapter. For the first time, we have an oral cavity chapter emphasizing oral findings at autopsy that correlate with systemic diseases. The funeral director and autopsy chapter is written by not only a physician but also a certified funeral director and embalmer. The photography chapter has been divided into photomicrography and gross autopsy pathology. So many changes, updates, and additions have been made that it was hard to recognize it as the same text but newer edition.
For whom is the book most appropriate?
The third edition covers so much more than the gross dissection. The autopsy is a medical procedure and is more than eviscerating. This book is complete; it covers common and not so common autopsy pathology findings and the appropriate techniques for detecting such. Organ systems are covered, including normal and abnormal. Special dissections are explained. This book is appropriate for all medical students, residents, pathologists, pediatricians, fetomaternal clinicians, forensic pathologists, placental/fetal pathologists, and radiologists. Honestly, I cannot think of a physician who would not find this text useful in his or her practice.
How does this autopsy book compare with others on the market?
I know of no other autopsy book like this on the market. It is extremely current, covers in depth the cause-of-death categories per organ system, and includes the latest technology from molecular pathology and ancillary laboratory studies to 3-D radiography. This edition even focuses on areas that many autopsy texts omit, such as the oral cavity, transplant pathology, placental pathology, organ and tissue procurement, and funeral practices, which are necessary to know when examining an embalmed or exhumed body.
The color images in the book are numerous and informative. The second edition contained only line drawings and no images. Can you tell us about the selection of the striking images in this new edition?
From the beginning, each author was asked for numerous high-quality images. For two years, these authors collected many that they thought were pertinent for the third edition. The numerous images are of high quality and are not redundant; they are complete and elaborate on the text. The fabulous tables pull information together in an organized “visual.” To discuss the topic is one thing, but to show the gross and histopathology pulls it together for the reader. It is a complete learning experience.
Former CAP president Gene Herbek, MD, writes in his foreword that about 40 percent of today’s autopsies generate unanticipated diagnoses. That is a high number. Can you comment on it as it relates to the low autopsy rate in many institutions and the chapter you coauthored on revitalization of the autopsy?
The number of autopsies has decreased across the country for various reasons. Financial issues always factor in. With the new technological advances in radiography and special studies in pathology and laboratory medicine, many clinicians and families feel disease can be diagnosed without an autopsy. They do not know what more they can learn. Unfortunately, this is untrue too often. Radiography and special laboratory studies complement patient care and the autopsy but are unable to detect many findings that the autopsy pathologist can. Furthermore, the autopsy allows postmortem studies such as molecular genetic pathology, vitreous chemistry, microbiology cultures, and sections for tumor bank and studies.
The autopsy goes beyond determining the cause of death. There are many autopsy diagnoses that are extremely important for the next of kin to know. So many diseases have a genetic and familial basis of which the next of kin need to be made aware. The autopsy also allows treating physicians to evaluate treatment regimens and to improve the overall public health.
Medical schools, residency programs, clinicians, and the public at large need to understand the value of the autopsy. They need to realize the many advances made in medicine that are due to autopsy studies and discoveries. The CAP has greatly improved the image of pathology and placed it at the center of patient treatment and the health care team. The same revitalization needs to happen to the autopsy. Unfortunately, some medical students never see an autopsy during their training. Therefore, as residents or practicing physicians they are unable to counsel families and use the autopsy to improve their own practice of medicine.
Would you like to say anything about the long list of distinguished contributors?
To cover each topic and chapter of this text on a current and thorough level, I knew I needed to seek out experts in each field—the best who are abreast of all changes and medical discoveries that take place around the world. Much thought went into the author selection. They are recognized by their peers and others as experts in their fields. I am so honored to have them contribute to this text. The reader deserves to “hear” from the best, learn from the best, see the amazing images these authors have collected, and feel confident applying this knowledge to the practice of autopsy pathology.
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To order Autopsy Performance & Reporting (PUB126), call 800-323-4040 option 1. For members, $128; for others, $160. For the ebook ($112), go to ebooks.cap.org.