Handbook of Autopsy Practice.
Article Type: Book review
Subject: Books (Book reviews)
Author: Rudner, Glenn
Pub Date: 05/01/2010
Publication: Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 College of American Pathologists ISSN: 1543-2165
Issue: Date: May, 2010 Source Volume: 134 Source Issue: 5
Topic: NamedWork: Handbook of Autopsy Practice, 4th ed. (Nonfiction work)
Persons: Reviewee: Waters, Brenda L.
Accession Number: 230246569
Full Text: 4th ed, edited by Brenda L. Waters, 596 pp, Totowa, NJ, Humana Press, 2009.

The Handbook of Autopsy Practice is in the 4th edition of the classic textbook of autopsy practice that was originally under the editorial guidance of Jurgen Ludwig, MD. Currently under the editorial direction of Brenda Waters, MD, and with the assistance of 11 contributing authors, including Dr Ludwig, this text has been updated from its 2002 third edition. This expanded edition, which now has 6 completely new chapters, hopefully provides insight to the pathologist on recent technologic advances in a subspecialty area of pathology that unfortunately continues to suffer from declining numbers along with fewer qualified and interested practioners. Since the publication of the last edition of this text, US-based pathology residency programs have been condensed, and with declining autopsy numbers residents may find themselves at the end of their training feeling ill equipped to handle anything beyond a very basic dissection. Even with marked technologic advancements in molecular diagnostics, postmortem imaging, and immunohistochemistry, the autopsy still remains as the proverbial gold standard for the assurance of the quality of mortality statistics, and, when properly performed, it is irreplaceable.

The 596-page text is clearly divided into 3 distinct and separate subsections. Part 1, "Autopsy Techniques and Procedures," is 156 pages and consists of 16 chapters. A wide range, but curious selection, of topics is included in this portion of the text and includes sections on the following: basic autopsy dissection techniques, quality control issues, fixation and transport of autopsy material, preparation of specimens for museum archiving, the medicolegal approach to the autopsy along with sample autopsy report protocols, and jurisdictional and death certification procedures. Brief, but separate, sections are also devoted to microbiology, chemistry, chromosomal analysis, postmortem imaging, handling of bodies with radioactive materials, and toxicology specimen collection. Organ-specific individual chapters on the cardiovascular system, the nervous system, and ocular adnexa essentially round out part 1.

The second part of the book, "Alphabetic Listing of Disease and Conditions," occupies 385 pages and consists of an alphabetical reference style tabulation of literally hundreds of different diseases and conditions with disease-specific dissection guidance techniques, possible findings, and references.

The third part of the book, "Normal Weights and Conditions," is a 35-page compilation of various tables of weights and measurements in infants, children, and adolescents. Separate weight and measurement tables are also provided for adults for individual organs and for placentas.

The target audience here is primarily resident pathologist trainees, as well as community-based pathologists who may not routinely perform a large volume of autopsies and who are interested in increasing the value of the autopsies that they perform. I found the subsection on the cardiovascular system to be well written with excellent gross pictures devoted to methodology of dissections of the conduction systems and to the various methods of cardiac dissection, areas of frequent confusion for those without a great deal of hands-on experience. I also found the text within the ocular and medicolegal and death certification subsections to be well focused. Overall, the quality of the black and white photos is good and refreshingly free of distracting background blood, while being illustrative of the technique described within the text. Similarly, I found the diagrams and tables within the first portion to appropriately compliment the text and in no way redundant.

Despite being the 4th edition of a text that has been in print for many years, it is not without its faults. The selection of topics in the first part of the book, as alluded to, I found somewhat disappointing. I have to think that individual sections devoted to the pediatric autopsy and to the myriad of pulmonary diseases, both of which are a frequent indication for the performance of an autopsy, would be of more practicality to a pathologist than chapters devoted to the preservation of museum pieces or the rarely performed ocular enucleation. I found that there is a fair amount of redundancy and repetition within the "Alphabetic Listing of Disease and Conditions" subsection, with many of the entities listed having only peripheral relevance to routine autopsy practice. If a 5th edition is in order, as a forensic pathologist, I would strongly suggest that the editors entirely eliminate the forensic sections within part 2 because there are far more useful textbooks to a forensic pathologist, and brief text descriptions of how to approach an autopsy in a patient with nonaccidental trauma, without any accompanying pictures, is of minimal value to those not properly trained in forensics.

Overall, Handbook of Autopsy Practice, 4th edition, is a practical reference source for its target audience and a good review source for those preparing for their board certification examinations, and it deserves a place on the departmental bookshelf.


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