Postmortem examinations in patients of a geriatric hospital

First virtual autopsy in Saudi Arabia: A case report with literature review

“…Studies have shown that the declining rate of non-coroner autopsies is caused by the creation of bioethics laws [36], patients views on the practice which makes it difficult to obtain consent from relatives; advances in modern diagnostic techniques [37,38], delay in obtaining autopsy reports [39], concerns about disfigurement and other cultural [40,41] or religious reasons. There is also a lack of satisfactory knowledge about autopsies in relatives and clinicians [42,43]. We believe that using virtual autopsy can solve most of these issues.…”

Doubts and certainness in diagnosis of pulmonary embolism in the elderly

“…Many of these risk factors, symptoms and signs in fact could be often also the main presentation of other diseases of which PE is a differential diagnosis, such as heart failure, acute coronary syndromes, chronic obstructive pulmonary disease, etc., more frequent in the geriatric patients. Table 2 Key issues in diagnosis of PE in the elderly Incidence, prevalence, morbidity and mortality increase steadily with age [21,22] PE is the acute cause of death in the elderly that is least suspected by physicians [2] Symptoms and signs are often nonspecific [1,15 -20] Accuracy of clinical pre-tests could be reduced [23] 12-leads electrocardiogram, chest X-ray and echocardiogram could have a lower specificity with respect to younger patients [16,18 -20] Hypoxemia and increased alveolar -arterial oxygen gradient have a high sensitivity and low specificity. Respiratory and metabolic acidosis could be more frequent [24,25] Only few elderly patients with suspected PE have a negative D-Dimer, making it less specific and increasing the diagnostic investigations to exclude PE [26,27].…”

“…This article arises important reflections on clinical picture and diagnostic approach to PE in the elderly that it should be important to highlight. Diagnosis of PE in fact is difficult in the elderly because of the nonspecificity of the clinical picture and the instrumental and laboratory tests, making this disease one of the main misdiagnoses in geriatric patients [2].…”

Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

“…L'EP rimane ancora oggi negli anziani la causa acuta di morte meno sospettata dai clinici. Il 40% dei casi di EP in pazienti anziani riscontrati al tavolo autoptico non è infatti diagnosticato ante mortem [18].…”