Navegando por Palavras-chave "Autópsia"
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- ItemAcesso aberto (Open Access)Correlação entre achados macro e microscópicos em 200 autópsias consecutivas: análise do valor custo/benefício do estudo histopatológico completo das autópsias(Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2002-07-01) Echenique, Leandro Santini; Mello, Regina de Arruda; Odashiro, Luciana Nakao; Franco, Marcello Fabiano de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Despite the development in diagnostic medicine, discrepancy between clinical diagnoses and the ones obtained by autopsy has remained around 10-20%. It is important to revert this tendency by measures that value the realization and optimization of autopsies. Objectives: Prospectively compare gross and microscopic findings of 200 autopsies, viewing to analyze the impact and the cost/benefit value of the histopathological study of all organs over provisory microscopic diagnoses and over enclosure final awards. Methods: We analyzed 200 consecutive autopsies performed at Departamento de Patologia da Escola Paulista de Medicina/UNIFESP and evaluated agreement and disagreement between provisory gross diagnoses and final microscopic ones. Results: There was agreement between gross and microscopic findings in 143 cases (71.5%) and disagreement in 22 cases (11%), classified as light in 14 cases (7%) and serious in eight cases (4%). In 35 cases (17.5%), histopathological study revealed alterations with no gross significance which had final histological diagnosis. Conclusion: The high agreement index detected between gross and microscopic findings, most discrepancies being classified as light, seems to indicate that autopsies may be closed with histopathological study limited to the most evident gross alterations, with significant cost reduction (around R$ 300 per autopsy) and great improvement in the return, in a short period of time, of information to the institution clinical staff.
- ItemAcesso aberto (Open Access)Correlation between surgical lung biopsy and autopsy findings and clinical data in patients with diffuse pulmonary infiltrates and acute respiratory failure(Faculdade de Medicina / USP, 2006-10-01) Canzian, Mauro; Soeiro, Alexandre de Matos; Taga, Marcel Frederico de Lima [UNIFESP]; Barbas, Carmen Silvia Valente; Capelozzi, Vera Luiza; São Paulo University Medical School Heart Institute Divisions of Respiratory Diseases and Pathology; São Paulo University Medical School Hospital das Clínicas Department of Pathology; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Surgical lung biopsy is an invasive procedure performed when other procedures have failed to provide an urgent and specific diagnosis, but there may be reluctance to perform it in critically ill patients with diffuse pulmonary infiltrates. PURPOSE: To evaluate the diagnostic accuracy, the changes in therapy and survival of patients with diffuse lung infiltrates, mostly presenting acute respiratory failure, who underwent surgical biopsy. METHODS: We retrospectively examined medical records and surgical lung biopsies from 1982 to 2003 of 63 patients older than 18 years with diffuse infiltrates. Clinical diagnoses were compared to histopathological ones, from biopsies and autopsies. Laboratory and epidemiological data were evaluated, and their relationship to hospital survival was analyzed. RESULTS: All histological specimens exhibited abnormalities, mostly presenting benign/inflammatory etiologies. Fifteen patients had an etiologic factor determined in biopsy, most commonly Mycobacterium tuberculosis. The preoperative diagnosis was rectified in 37 patients. Autopsies were obtained in 25 patients and confirmed biopsy results in 72% of cases. Therapy was changed for 65% of patients based on biopsy results. Forty-nine percent of patients survived to be discharged from the hospital. Characteristics that differed significantly between survivors and nonsurvivors included sex (P = 0.05), presence of comorbidity (P = 0.05), SpO2 (P = 0.05), and presence of diffuse alveolar damage in the biopsy (P = 0.004). CONCLUSION: Surgical lung biopsy provided a specific, accurate etiologic diagnosis in many patients with diffuse pulmonary infiltrates when clinical improvement did not occur after standard treatment. Surgical lung biopsy may reveal a specific diagnosis that requires distinct treatment, and it would probably have an impact in lowering the mortality of these patients.
- ItemAcesso aberto (Open Access)Lesões fatais em trauma numa grande metrópole Brasileira: um estudo de autópsias(Colégio Brasileiro de Cirurgiões, 2011-04-01) Wilson, Jorge L [UNIFESP]; Herbella, Fernando A. M [UNIFESP]; Takassi, Guilherme F [UNIFESP]; Moreno, Danilo G [UNIFESP]; Tineli, Ana C [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: This study aims to review a series of deaths by trauma in a large metropolis. The intention is to identify preventable causes of death. METHODS: We prospectively studied 500 unselected and consecutive cases of death associated with trauma. The study variables were: mechanism of injury, etiology, site of injury, surgical intervention, medical malpractice, damaged organs and the prevention of mortality. The cases were grouped according to the mechanism of injury in: penetrating trauma, blunt trauma, poisoning, drowning, burns and suffocation. RESULTS: We examined 418 (83.6%) males and 82 (16.4%) females (mean age 39 ± 19.6 years, ranging from three to 91 years). Penetrating trauma accounted for 217 (43%) cases, while blunt trauma accounted for 40% of cases. The most common mechanism of injury in death by penetrating trauma was gunshot, representing 41% of cases. Within the set of blunt trauma, the most common mechanism was traffic accident, which represented 22% of total deaths. There were 71 (14%) cases of preventable deaths: thromboembolism in 35 (7%), infectious complications in 25 (5%), medical malpractice in seven (1%) and treatable lesions in outpatients in five (1%). CONCLUSION: This study shows that traumatic death in the city of São Paulo is associated with serious and complex injuries. Prevention of these types of death would be related to the control of violence.