SPARING THE DEAD

During the 3rd year of medical school, students are taken to the police morgue to witness the procedures that uncover the cause of death in suspected
cases of suicide or homicide.
Believe me, after the gruesome sights and smells (fortunately the dead make no sounds), each student becomes set for life and hardened to things that can fell alpha males in feminine faints.
The conventional autopsy is done by slitting open the body cavities from neck to the pelvis with a long clean cut . One by one, the organs are examined and parts removed, weighed and sent for toxicologic studies. At the end of it all, the skin is sewn up, the hollow of the empty chest and abdominal cavities hidden from view.
Is it small wonder that almost all Indians refuse consent for an autopsy if they have a choice?
Autopsies, however, have a very vital role to play in determining the cause of death, and in medical education. The dead teach the living, they say!
In recent times, forensic scientists have woken up to the need to improve this primitive and ghastly method of mutilating a human body in the name of science.
Forensic experts in the University of Bern, Switzerland, have pioneered a new technique of post mortem examination. This is now called ‘Virtopsy’, a virtual autopsy.
Using multi-slice CT scanners and MRI machines, the dead body is scanned thoroughly. Internal body parts are clearly seen, revealing injuries and diseases that would have normally needed a neck to pubis incision. In fact, in the Japanese city of Chiba scientists are using portable CT scanners for head and other injuries and detecting skull fractures and other lesions that conventional PM examinations have missed!
In bullet injuries and traffic accidents, the CT scanner is used to give a three dimensional image of the head. The computer reconstructs exactly where the bullet must have gone in and out. In fact, as the Bern group has shown recently, these images can be animated to give a more real-life look to the detectives hunting out the mechanism of death!
The implications of this are far ranging, including assessment of vehicle safety and mechanism of accidents to the passengers and pedestrians.
Another new way to avoid the trauma of a PM is angiography with CT or MRI scan.
By this technique, a catheter is passed into the femoral artery at the groin and up to the heart. Radio-opaque dye is injected and the body scanned by the machine. A thorough exposition of the anatomy of the blood vessels is obtained, leading to clear diagnosis of the mechanism of anatomical injuries as well as the detection of pre-existing diseases like atherosclerosis.
This is the era of minimally invasive surgery, as we all know. Laparoscopic autopsy is now a real option. The procedure is done by placing high definition endoscopic video cameras into the body cavities through small keyhole like cuts. Thin, long instruments are inserted for examining the
organs, removing parts for special tests, if necessary. This new procedure has the advantages that the consent for the post mortem has increased sharply, because it is easier to accept 10 mm and 5 mm cuts on the body of a loved one rather than one measured in feet! In addition, minimally invasive autopsy has been shown to be accurate and obtains as much information as open autopsy.
Even unborn fetuses that die in utero are now being subjected to autopsy examination, often with ultrasononography correlation.
In a recent original article in the Journal of Perinatology, SR Phadke and VH Sankar of Lucknow‘s Sanjay Gandhi Post Graduate Institute of Medical Sciences have shown the feasibility of this. Prenatal ultrasound can detect the anomaly causing fetal death. Then why the need for an autopsy? This is because it detects additional malformations in another one-third of cases. This helps the geneticist in counseling the parents so that they are spared the trauma of subsequent stillbirths and abortions.
Unfortunately, the benefits of virtopsy are giving this country the short shrift.
The costs of a multi-slice CT scan and MRI, etc. are more than a million dollars apiece. If the State teaching Hospitals use their machines for this purpose, many more cases of “death due to unknown cause” may see the light of revealed truth. In addition, laparoscopic equipment in hospitals could be used for the same.
The dead must be indulging in some wishful thinking to be spared the cruel knife of the pathologist!

One response to “SPARING THE DEAD

  1. A very good post 🙂
    I have read many post mortem reports and even reading them gives me the creeps !

    u have a nice blog here 🙂

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