Pas assez fou pour mettre le feu

L’article défie la pérennité du pouvoir psychiatrique dans le monde occidental. Comme on n’est fou qu’en relation avec une société donnée, nous trouvons légitime de se demander si la psychiatrie, en dépit de ses prémisses scientifiques, a en plus de 100 ans de pratique réellement contribué à améliorer l’existence de l’individu qui a reçu un traitement psychiatrique. En psychiatrie, on est seulement passé de la camisole physique à une camisole chimique.This article challenges the perenniality of psychiatric power in the western world. As one is crazy only in relation to a given society, we find it legitimate to ask whether psychiatry, in spite of its scientific premises, has in over 100 years of practice really contributed to improving existence of the individual that have received psychiatric treatment. In psychiatry we have merely gone from physical straightjacket to a chemical straight]acket

Quantification of Maceration Changes using Post Mortem MRI in Fetuses

BACKGROUND: Post mortem imaging is playing an increasingly important role in perinatal autopsy, and correct interpretation of imaging changes is paramount. This is particularly important following intra-uterine fetal death, where there may be fetal maceration. The aim of this study was to investigate whether any changes seen on a whole body fetal post mortem magnetic resonance imaging (PMMR) correspond to maceration at conventional autopsy. METHODS: We performed pre-autopsy PMMR in 75 fetuses using a 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany). PMMR images were reported blinded to the clinical history and autopsy data using a numerical severity scale (0 = no maceration changes to 2 = severe maceration changes) for 6 different visceral organs (total 12). The degree of maceration at autopsy was categorized according to severity on a numerical scale (1 = no maceration to 4 = severe maceration). We also generated quantitative maps to measure the liver and lung T2. RESULTS: The mean PMMR maceration score correlated well with the autopsy maceration score (R(2) = 0.93). A PMMR score of ≥4.5 had a sensitivity of 91%, specificity of 64%, for detecting moderate or severe maceration at autopsy. Liver and lung T2 were increased in fetuses with maceration scores of 3-4 in comparison to those with 1-2 (liver p = 0.03, lung p = 0.02). CONCLUSIONS: There was a good correlation between PMMR maceration score and the extent of maceration seen at conventional autopsy. This score may be useful in interpretation of fetal PMMR

An intriguing autopsy case of gangrene intestine

Background Hashimoto’s thyroiditis is one of the most common causes of hypothyroidism. Hypothyroidism is a known cause of hyperlipidemia. There is a strong correlation between coronary and mesenteric vessel atherosclerosis. Acute mesenteric ischemia is a cause of intestinal hemorrhagic infarction. Case history We present an autopsy case of 35-year-old male who presented with features of obstruction and edema with previously undetected hypothyroidism. Conclusion Hypothyroidism associated with atherosclerosis can lead to fatal intestinal gangrene as corroborated by this autopsy case. Key words –Hypothyroidism, intestinal gangrene, autopsy, atherosclerosi

Autopsy in adults with congenital heart disease (ACHD).

The adult congenital heart diseases (ACHD) population is exceeding the pediatric congenital heart diseases (CHD) population and is progressively expanding each year, representing more than 90% of patients with CHD. Of these, about 75% have undergone surgical and/or percutaneous intervention for palliation or correction. Autopsy can be a very challenging procedure in ACHD patients. The approach and protocol to be used may vary depending on whether the pathologists are facing native disease without surgical or percutaneous interventions, but with various degrees of cardiac remodeling, or previously palliated or corrected CHD. Moreover, interventions for the same condition have evolved over the last decades, as has perioperative myocardial preservations and postoperative care, with different long-term sequelae depending on the era in which patients were operated on. Careful clinicopathological correlation is, thus, required to assist the pathologist in performing the autopsy and reaching a diagnosis regarding the cause of death. Due to the heterogeneity of the structural abnormalities, and the wide variety of surgical and interventional procedures, there are no standard methods for dissecting the heart at autopsy. In this paper, we describe the most common types of CHDs that a pathologist could encounter at autopsy, including the various types of surgical and percutaneous procedures and major pathological manifestations. We also propose a practical systematic approach to the autopsy of ACHD patients

Aetiology of sudden cardiac death in sport: a histopathologist's perspective.

In the UK, when a young person dies suddenly, the coroner is responsible for establishing the cause of death. They will ask a consultant pathologist to carry out an autopsy in order to ascertain when, where and how that person died. Once the cause of death is established and is due to natural causes, the coroner can issue a death certificate. Importantly, the coroner is not particularly interested in the cause of death as long as it is due to natural causes, which avoids the need for an inquest (a public hearing about the death). However, if no identifiable cause is established at the initial autopsy, the coroner can refer the heart to a cardiac pathologist, since the cause of death is usually due to heart disease in most cases. Consultant histopathologists are responsible for the analysis of human tissue from both living individuals and the dead in order to make a diagnosis of disease. With recent advancements in the management protocols for routine autopsy practice and assessment following the sudden death of a young individual, this review describes the role of the consultant histopathologist in the event of a sudden death of a young athletic individual, together with the older middle-aged 'weekend warrior' athlete. It provides concise mechanisms for the main causes of sudden cardiac death (including coronary artery disease, cardiomyopathies, valve abnormalities, major vessel ruptures and electrical conduction abnormalities) based on detailed autopsy data from our specialised cardiac pathology laboratory. Finally, the review will discuss the role of the histopathologist in the event of a 'negative' autopsy

Association of Cystic Medial Necrosis of the Aorta and Undiagnosed Thyroiditis [Scripta Medica]

We have recently seen two patients with cystic medial necrosis of the aorta. The first patient died of a dissecting aneurysm of the thoracic aorta. At autopsy, classical Hashimoto’s thyroiditis was discovered. The second patient died of a rupture of the ascending aorta. At autopsy, chronic thyroiditis was seen with multiple large germinal center and diffuse fibrosis. Neither patient was clinically suspected of thyroid dysfunction although the second patient had had a partial thyroidectomy in the remote past

The Autopsy, medicine, and mortality statistics

"Articles previously published separately in Archives of Internal Medicine. Randy Hanzlick, M.D. (Editor) and the Autopsy Committee of the College of American Pathologists. Produced with Permission of the Archives of Internal Medicine and the American Medical Association. Published by the National Center for Health Statistics."[Randy Hanzlick (editor) and the Autopsy Committee of the College of American Pathologists]."October 2001."Includes bibliographical references

Destructive Hostility: The Jeffrey Dahmer Case: A Psychiatric and Forensic Study of a Serial Killer

We were involved as forensic experts in the case of the serial killer Jeffrey Dahmer. We discuss the scene and victim autopsy findings, with a brief consideration of the basic emotion of hostility. These findings support the thesis that at the basis of this serial killer\u27s behavior were primary unconscious feelings of hate that he had channeled into a sadistic programmed destruction of 17 young men. The interview of the serial killer, the photographic scene documentation, and the autopsy findings stress the ambivalent homosexuality of the killer, his sexual sadism, his obsessive fetishism, and his possible cannibalism and necrophilia