The definition of the term autopsy varies according to the source and here are some examples: Oxford Dictionary: “A post-mortem examination to discover the cause of death or the extent of disease.”; Cambridge Dictionary: “the cutting open and examination of a dead body in order to discover the cause of death”; Collins English Dictionary: “An autopsy is an examination of a dead body by a doctor who cuts it open in order to try to discover the cause of death.”; The Merrian-Webster Dictionary: “1: an examination of a body after death to determine the cause of death or the character and extent of changes produced by disease –called also necropsy; 2: a critical examination, evaluation, or assessment of someone or something past” and Illustrated Stedman’s Medical Dictionary, Williams and Wilkins, Baltimore 1982, 24th Ed “Postmortem examination; necropsy; thanatopsy: an examination of the internal organs of a dead body for the purpose of determining the cause of death or of studying the pathologic changes present.” As can be seen in these definitions, the primary aim of the autopsy is to determine the cause of death and there is no mention to how this can be achieved apart from cutting, dissecting, we should say. Pathologists, however, know that the autopsy is much more than simply dissecting a dead body as we also rely on further analysis that may involve histological examination of samples of organs and tissues as well as imaging, cyto or molecular genetics, microbiology, virology, toxicology and metabolic studies where applicable. Other techniques can be used in specific cases, such as electron microscopy. The autopsy is no longer the sole examination and dissecting of the dead body and is more appropriately called a Postmortem Examination. As new technologies become available, they can be incorporated in the range already in use and, therefore, the role of the Pathologist is ever changing. In the United Kingdom, there are two basic types of Postmortem (PM) Examination: Hospital and Coronial, which includes Forensic cases. The Coroner is an independent judicial office holder, who is a lawyer, a doctor or both appointed and paid by the relevant local authority with the mission of inquiring into unnatural deaths. The Coronial system has been around in England and Wales for over 700 years. Coronial PMs are warranted when no doctor attended the deceased during his/her last illness, when the deceased was not seen by a doctor in the last two weeks before death, when the cause of death appears to be unknown, when death occurred during an operation of before recovery from the effects of an anaesthetic, when death occurred at work or was due to industrial disease or poisoning, when death was sudden or unexpected, when death was unnatural, due to violence, neglect or in suspicious circumstances and finally when it occurred in prison, police custody or other state detention.1 All these deaths are reported to the Coroner of the area who will then instruct a Pathologist and or a Forensic Pathologist to perform the examination. No consent is necessary for Coronial PMs. In the United Kingdom, when the patient dies in hospital or related places, the doctor in charge is responsible for issuing a death certificate if the cause of death is known and there are no circumstances that demand necessarily a Post-mortem Examination, as mentioned above. However, if there are still pending issues that require a better understanding, a Post-mortem Examination may be requested on medical grounds but can only happen with informed consent by a family member or legal guardian. This also applies to foetal deaths, including terminations of pregnancy for whatever reason. Almost all adult PMs in the UK are coronial and the main objective is to determine the cause of death. It is estimated that only in England and Wales there are about 90,000 coronial PMs per year. In the paediatric age range, however, it is very different. At Sheffield Children’s Hospital, for example, there are about 450 PMs per year with about 90 (20%) being coronial cases of which about 12 (2.7%) are Forensic PMs. Hospital PMs therefore correspond to 80%, in sharp contrast with adults. As a legal requirement, paediatric forensic PMs are conducted by two doctors: a Forensic Pathologist and a Paediatric Pathologist. It is therefore recognised that the peculiarities of the foetal and paediatric cases are enough to warrant a detailed examination by a devoted paediatric pathologist who will base his/her conclusions not only based on macro and macroscopic features, but on a full range of ancillary tests such as microbiology of blood, tissue, body fluids and secretions; virology of blood, stools, cerebro-spinal fluid and lung sample; cytogenetics and molecular genetics; electrolyte profile from the vitreous humor; metabolic investigation in dry blood spots (Guthrie cards) or in skin fibroblasts; toxicology screening in the blood, urine or bile and skeletal survey. The cost of a paedi
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